Provider Demographics
NPI:1952991986
Name:5 ELEMENTS COACHING LLC
Entity Type:Organization
Organization Name:5 ELEMENTS COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-818-3064
Mailing Address - Street 1:19813 LEITERSBURG PIKE # 193
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1445
Mailing Address - Country:US
Mailing Address - Phone:240-406-4857
Mailing Address - Fax:240-202-2476
Practice Address - Street 1:226 N POTOMAC ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-3813
Practice Address - Country:US
Practice Address - Phone:240-406-4857
Practice Address - Fax:240-202-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-23
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTHEROtherOTHER