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General NPI Number Information
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NPI Number | 1356321624
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Entity Type | Organization
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Legal Business Name | ELDERS HOME INC
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 215 S TOUSLEY AVE
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City | NEW YORK MILLS
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State | MN
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Zip | 56567
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Country | US
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Telephone | 218-385-2005
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Fax | 218-385-4170
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Provider Business Mailing Address
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Address Line | PO BOX 188
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City | NEW YORK MILLS
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State | MN
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Zip | 56567
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Country | US
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Telephone | 218-385-2005
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Fax | 218-385-4170
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. CALVIN BRUCE ANDERSON
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Credential | LNHA
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Telephone | 218-385-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 329990
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License Number State | MN
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