Provider Demographics
NPI:1245740307
Name:ELOHIM HOMECARE AND STAFFING AGENCY INC
Entity Type:Organization
Organization Name:ELOHIM HOMECARE AND STAFFING AGENCY INC
Other - Org Name:ELOHIM HOMECARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PRUDENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEPKOSGEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-727-1760
Mailing Address - Street 1:6165 NW 86TH ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2270
Mailing Address - Country:US
Mailing Address - Phone:515-727-1760
Mailing Address - Fax:515-727-1601
Practice Address - Street 1:6165 NW 86TH ST
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2270
Practice Address - Country:US
Practice Address - Phone:515-727-1760
Practice Address - Fax:515-727-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251E00000X, 251G00000X, 251S00000X, 253J00000X, 253Z00000X, 261QM0850X, 310500000X, 315P00000X, 332900000X, 385HR2060X
IA251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No332900000XSuppliersNon-Pharmacy Dispensing Site
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA=========OtherIRS