Provider Demographics
NPI:1104219625
Name:ELEMENTAL HEALTH
Entity Type:Organization
Organization Name:ELEMENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LMHC
Authorized Official - Phone:401-741-0853
Mailing Address - Street 1:1544 FRENCHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1311
Mailing Address - Country:US
Mailing Address - Phone:401-741-0853
Mailing Address - Fax:
Practice Address - Street 1:1544 FRENCHTOWN RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1311
Practice Address - Country:US
Practice Address - Phone:401-741-0853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-08
Last Update Date:2015-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00663101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICK42287Medicaid