Provider Demographics
NPI:1750859849
Name:HARDIN, ELAM
Entity Type:Individual
Prefix:
First Name:ELAM
Middle Name:
Last Name:HARDIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 B ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-5004
Mailing Address - Country:US
Mailing Address - Phone:510-850-6857
Mailing Address - Fax:510-581-5843
Practice Address - Street 1:590 B STREET
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541
Practice Address - Country:US
Practice Address - Phone:510-247-8239
Practice Address - Fax:510-581-5843
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator