=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861352684
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELEOS HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2025
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11800 ELDORADO ST NW APT 113
-----------------------------------------------------
City | COON RAPIDS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55433-2874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-528-4405
-----------------------------------------------------
Fax | 651-358-2300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11800 ELDORADO ST NW APT 113
-----------------------------------------------------
City | COON RAPIDS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55433-2874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-528-4405
-----------------------------------------------------
Fax | 651-358-2300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | JOYCE HAJA KENEWA
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 651-528-4405
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------