Provider Demographics
NPI:1265818850
Name:HEALTH FULL ELEMENTS
Entity Type:Organization
Organization Name:HEALTH FULL ELEMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER; MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKUBOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:586-216-0990
Mailing Address - Street 1:25797 CURIE AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-3829
Mailing Address - Country:US
Mailing Address - Phone:586-216-0990
Mailing Address - Fax:
Practice Address - Street 1:11443 E 13 MILE RD
Practice Address - Street 2:404
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2589
Practice Address - Country:US
Practice Address - Phone:586-216-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501004559171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty