Provider Demographics
NPI:1700033495
Name:COMMUNITY ELEMENTS, INC
Entity Type:Organization
Organization Name:COMMUNITY ELEMENTS, INC
Other - Org Name:RESPITE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXEC OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-398-8080
Mailing Address - Street 1:1801 FOX DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7236
Mailing Address - Country:US
Mailing Address - Phone:217-398-8080
Mailing Address - Fax:
Practice Address - Street 1:502 N MARKET ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3634
Practice Address - Country:US
Practice Address - Phone:217-398-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY ELEMENTS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-25
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831167337OtherTRICARE
1831167337OtherBLUE CROSS
1831167337OtherBLUE CROSS