Provider Demographics
NPI:1205824968
Name:ELIM HOMES, INC.
Entity Type:Organization
Organization Name:ELIM HOMES, INC.
Other - Org Name:PROGRESSIVE REHABILITATION OPTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SEELOCHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:STADTHERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-855-5041
Mailing Address - Street 1:200 LEWIS AVE S
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WATERTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55388-4545
Mailing Address - Country:US
Mailing Address - Phone:952-955-2242
Mailing Address - Fax:952-955-2010
Practice Address - Street 1:200 LEWIS AVE S
Practice Address - Street 2:SUITE 210
Practice Address - City:WATERTOWN
Practice Address - State:MN
Practice Address - Zip Code:55388-4545
Practice Address - Country:US
Practice Address - Phone:952-955-2242
Practice Address - Fax:952-955-2010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIM CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-07
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN246546225100000X, 225X00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN756555100Medicaid
MN756555100Medicaid