MEDICARE: ELM CREST MANOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	1086A	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144218769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELM CREST MANOR

Provider Business Mailing Address
First Line	:	100 ELM AVE
Second Line	:
City	:	NEW SALEM
State	:	ND
Zip	:	58563-4031
Country	:	US
Telephone Number	:	701-843-7526
Fax Number	:	701-843-8376

Provider Business Practice Location Address
First Line	:	100 ELM AVE
Second Line	:
City	:	NEW SALEM
State	:	ND
Zip	:	58563-4031
Country	:	US
Telephone Number	:	701-843-7526
Fax Number	:	701-843-8376

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JANESSA VOGEL
Credential	:
Telephone Number	:	701-843-7526

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	04/23/2015

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Directions to “ELM CREST MANOR ” Practice Location

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