Organization
ELICIA HOMECARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELLE CLERMONT KANNEH (EXECUTIVE DIRECTOR)
(612) 709-3880
Entity
Organization
Contact information
Practice address
7100 NORTHLAND CIR N STE 123, BROOKLYN PARK, MN 55428-1500
(612) 709-3880
(612) 454-2583
Mailing address
7100 NORTHLAND CIR N STE 123, BROOKLYN PARK, MN 55428-1500
(612) 709-3880
(612) 454-2583
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
310400000X
Assisted Living Facility
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
342000000X
Transportation Network Company
—
—
343800000X
Secured Medical Transport (VAN)
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
03/20/2023
Last updated
10/29/2025
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