Provider Demographics
NPI:1215383898
Name:ELOHIM HOME CARE LLC
Entity Type:Organization
Organization Name:ELOHIM HOME CARE LLC
Other - Org Name:NITEZEHO LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN DE DIEU
Authorized Official - Middle Name:
Authorized Official - Last Name:NITEZEHO NIYOMUGABO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-891-8809
Mailing Address - Street 1:4300 BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3773
Mailing Address - Country:US
Mailing Address - Phone:701-891-8809
Mailing Address - Fax:
Practice Address - Street 1:310 SE GATEWAY DR APT 139
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-8747
Practice Address - Country:US
Practice Address - Phone:701-891-8809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2Medicaid