Provider Demographics
NPI:1902098825
Name:ELM PLACE LLC
Entity Type:Organization
Organization Name:ELM PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-815-7198
Mailing Address - Street 1:101 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:SWEET SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65351-1201
Mailing Address - Country:US
Mailing Address - Phone:660-815-7198
Mailing Address - Fax:
Practice Address - Street 1:101 S ELM ST
Practice Address - Street 2:
Practice Address - City:SWEET SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:65351-1201
Practice Address - Country:US
Practice Address - Phone:660-815-7198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities