Healthcare Provider Details

I. General information

NPI: 1467380691
Provider Name (Legal Business Name): ELEMENTS OF HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10941 105TH AVE N
MAPLE GROVE MN
55369-2837
US

IV. Provider business mailing address

10941 105TH AVE N
MAPLE GROVE MN
55369-2837
US

V. Phone/Fax

Practice location:
  • Phone: 612-834-7693
  • Fax:
Mailing address:
  • Phone: 612-834-7693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: DANA TUTLAND
Title or Position: FOUNDER
Credential: CAPS
Phone: 612-834-7693