Healthcare Provider Details

I. General information

NPI: 1144218769
Provider Name (Legal Business Name): ELM CREST MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ELM AVE
NEW SALEM ND
58563-4031
US

IV. Provider business mailing address

100 ELM AVE
NEW SALEM ND
58563-4031
US

V. Phone/Fax

Practice location:
  • Phone: 701-843-7526
  • Fax: 701-843-8376
Mailing address:
  • Phone: 701-843-7526
  • Fax: 701-843-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1086A
License Number StateND

VIII. Authorized Official

Name: JANESSA VOGEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-843-7526