Healthcare Provider Details

I. General information

NPI: 1821340712
Provider Name (Legal Business Name): ELIM HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3534 UNIVERSITY DR S
FARGO ND
58104-6228
US

IV. Provider business mailing address

200 LEWIS AVE S STE# 210
WATERTOWN MN
55388-4545
US

V. Phone/Fax

Practice location:
  • Phone: 701-271-1817
  • Fax: 701-271-1926
Mailing address:
  • Phone: 952-955-2242
  • Fax: 952-955-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1475
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JEFF J DAGEN
Title or Position: PRESIDENT
Credential: RPT
Phone: 952-955-2242