Provider Demographics
NPI:1053804039
Name:ELBA, MICHELE A (SWA/CARE COORDINATOR)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:ELBA
Suffix:
Gender:F
Credentials:SWA/CARE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 EUCLID AVE STE 33
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2408
Mailing Address - Country:US
Mailing Address - Phone:234-334-2393
Mailing Address - Fax:
Practice Address - Street 1:2800 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2408
Practice Address - Country:US
Practice Address - Phone:216-798-4250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172V00000X, 171M00000X
OHCDCA.173588101YA0400X
OHS.2001623-TRNE104100000X
OHW.2100299104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator