Provider Demographics
NPI:1821340712
Name:ELIM HOMES
Entity Type:Organization
Organization Name:ELIM HOMES
Other - Org Name:DBA PRO REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:952-955-2242
Mailing Address - Street 1:200 LEWIS AVE S
Mailing Address - Street 2:STE# 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 1:3534 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6228
Practice Address - Country:US
Practice Address - Phone:701-271-1817
Practice Address - Fax:701-271-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1475314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility