Provider Demographics
NPI:1679313647
Name:ELEMENTAL HEALTH SPA LTD
Entity type:Organization
Organization Name:ELEMENTAL HEALTH SPA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTINS
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEOYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-289-5900
Mailing Address - Street 1:14484 JOHN HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2638
Mailing Address - Country:US
Mailing Address - Phone:224-289-5900
Mailing Address - Fax:224-289-5909
Practice Address - Street 1:14484 JOHN HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2638
Practice Address - Country:US
Practice Address - Phone:224-289-5900
Practice Address - Fax:224-289-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty