Provider Demographics
NPI:1275086373
Name:ELEMENTS OF HEALTH LLC
Entity Type:Organization
Organization Name:ELEMENTS OF HEALTH LLC
Other - Org Name:ELEMENTS OF HEALTH LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-236-5043
Mailing Address - Street 1:7101 N GREEN BAY AVE
Mailing Address - Street 2:SUTIE 8
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3644
Mailing Address - Country:US
Mailing Address - Phone:414-236-5043
Mailing Address - Fax:414-236-5118
Practice Address - Street 1:7101 N GREEN BAY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-3644
Practice Address - Country:US
Practice Address - Phone:414-462-3383
Practice Address - Fax:414-462-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100041698Medicaid