Elcm Homestead Management LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

IN PROCESS Issued in VT

Legal business name

ELCM HOMESTEAD MANAGEMENT LLC

Practice address

3 Harbor View Dr
Saint Albans, VT 05478-4477

Phone

(802) 752-2100

Fax

(802) 752-2057

NPI assigned

Sep 1, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paul Boethel

Title

Principal

Phone

(972) 728-8739

Specialties & licenses 1

Addresses

Other names 1

• Homestead at Pillsbury Manor Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1669929006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14241 DALLAS PKWY",
            "address_2": "SUITE 650",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752542936",
            "telephone_number": "972-728-8743",
            "fax_number": "214-594-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 HARBOR VIEW DR",
            "city": "SAINT ALBANS",
            "state": "VT",
            "postal_code": "054784477",
            "telephone_number": "802-752-2100",
            "fax_number": "802-752-2057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELCM HOMESTEAD MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "BOETHEL",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "972-728-8739",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "VT",
            "license": "IN PROCESS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Homestead at Pillsbury Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Desiree Dutkiewicz
• Marc Dutkiewicz, LADC
• Jennifer F Eaton, M.D.
• Edward Pomicter, MD
• Angela Elcan, BCBA
• Vincent Onchwati Elijah, PHARMD
• Elite Health and Wellness LLC
• Elizabeth Nelson DMD PC
• Cynthia Ellis, PTA
• Coretta Jean Enos, LICSW

• All providers in Saint Albans, VT
• Adult Care Home Facility in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.