Provider Demographics
NPI:1992075428
Name:NELS HEALTH CARE, LLC
Entity type:Organization
Organization Name:NELS HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NYONUNFON
Authorized Official - Middle Name:
Authorized Official - Last Name:NDIKINTUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-917-3874
Mailing Address - Street 1:3501 SECTION RD #410
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237
Mailing Address - Country:US
Mailing Address - Phone:651-500-7788
Mailing Address - Fax:
Practice Address - Street 1:2285 STEWART AVE
Practice Address - Street 2:SUITE 1107
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116
Practice Address - Country:US
Practice Address - Phone:651-500-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2017-03-17
Deactivation Date:2012-12-07
Deactivation Code:
Reactivation Date:2017-03-10
Provider Licenses
StateLicense IDTaxonomies
MN355986163W00000X, 164W00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty