Provider Demographics
NPI:1821130436
Name:ELM NORTH INC
Entity Type:Organization
Organization Name:ELM NORTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-835-1146
Mailing Address - Street 1:204 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-2544
Mailing Address - Country:US
Mailing Address - Phone:507-835-1146
Mailing Address - Fax:507-835-4574
Practice Address - Street 1:104 22ND AVE NE
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2610
Practice Address - Country:US
Practice Address - Phone:507-835-1146
Practice Address - Fax:507-835-4574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities