MEDICARE: ELIM HOMES, INC.

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	328427	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	328427	OTHER	MN	MINNESOTA STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356339006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIM HOMES, INC.

Provider Business Mailing Address
First Line	:	409 JEFFERSON AVE SW
Second Line	:
City	:	WATERTOWN
State	:	MN
Zip	:	55388-9250
Country	:	US
Telephone Number	:	952-955-2691
Fax Number	:	952-955-3799

Provider Business Practice Location Address
First Line	:	409 JEFFERSON AVE SW
Second Line	:
City	:	WATERTOWN
State	:	MN
Zip	:	55388-9250
Country	:	US
Telephone Number	:	952-955-2691
Fax Number	:	952-955-3799

Authorized Official
Title or Position	:	SENIOR DIRECTOR OF REIMBURSEMENT
Name	:	SEELOCHANI STADTHERR
Credential	:
Telephone Number	:	952-855-5041

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	10/12/2023

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