Provider Demographics
NPI:1932445889
Name:ELIM HOMES, INC. D.B.A. PRO REHAB
Entity Type:Organization
Organization Name:ELIM HOMES, INC. D.B.A. PRO REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUCETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:952-955-2242
Mailing Address - Street 1:200 LEWIS AVE S STE 210
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55388-4547
Mailing Address - Country:US
Mailing Address - Phone:952-955-2242
Mailing Address - Fax:952-955-2010
Practice Address - Street 1:201 SHADY LANE DR
Practice Address - Street 2:201 SHADY LANE DRIVE
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-3093
Practice Address - Country:US
Practice Address - Phone:218-631-1391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9130314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility