Healthcare Provider Details

I. General information

NPI: 1679313647
Provider Name (Legal Business Name): ELEMENTAL HEALTH SPA LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14484 JOHN HUMPHREY DR
ORLAND PARK IL
60462-2638
US

IV. Provider business mailing address

14484 JOHN HUMPHREY DR
ORLAND PARK IL
60462-2638
US

V. Phone/Fax

Practice location:
  • Phone: 224-289-5900
  • Fax: 224-289-5909
Mailing address:
  • Phone: 224-289-5900
  • Fax: 224-289-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MARTINS ADEOYE
Title or Position: CEO
Credential: MD
Phone: 224-289-5900