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
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
310400000X
Assisted Living Facility
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
Other
Enumeration date
04/04/2023
Last updated
09/26/2025
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