Provider Demographics
NPI:1144218769
Name:ELM CREST MANOR
Entity Type:Organization
Organization Name:ELM CREST MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-843-7526
Mailing Address - Street 1:100 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW SALEM
Mailing Address - State:ND
Mailing Address - Zip Code:58563-4031
Mailing Address - Country:US
Mailing Address - Phone:701-843-7526
Mailing Address - Fax:701-843-8376
Practice Address - Street 1:100 ELM AVE
Practice Address - Street 2:
Practice Address - City:NEW SALEM
Practice Address - State:ND
Practice Address - Zip Code:58563-4031
Practice Address - Country:US
Practice Address - Phone:701-843-7526
Practice Address - Fax:701-843-8376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1086A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND030116Medicaid
ND355110Medicare Oscar/Certification