Healthcare Provider Details

I. General information

NPI: 1568908739
Provider Name (Legal Business Name): ELEMENTAL CARE - HEALTH & WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20660 CATON FARM RD UNIT F
CREST HILL IL
60403-1201
US

IV. Provider business mailing address

20660 CATON FARM RD UNIT F
CREST HILL IL
60403-1201
US

V. Phone/Fax

Practice location:
  • Phone: 815-714-5430
  • Fax: 815-714-5369
Mailing address:
  • Phone: 815-714-5430
  • Fax: 815-714-5369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBERT GALLOWAY
Title or Position: CEO
Credential:
Phone: 815-714-5430