Provider Demographics
NPI:1073238572
Name:ELEMENTS AT LAKEWOOD, LLC
Entity Type:Organization
Organization Name:ELEMENTS AT LAKEWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-351-1886
Mailing Address - Street 1:1700 CEDAR SPRINGS ROAD
Mailing Address - Street 2:APT 1304
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6205 LA VISTA DRIVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-4312
Practice Address - Country:US
Practice Address - Phone:646-509-7035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility