Provider Demographics
NPI:1194009563
Name:5 ELEMENTS HEALTH & WELLNESS, LLC
Entity type:Organization
Organization Name:5 ELEMENTS HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEIER-ABDELMAWGOUD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:414-418-8187
Mailing Address - Street 1:1335 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-3533
Mailing Address - Country:US
Mailing Address - Phone:414-418-8187
Mailing Address - Fax:
Practice Address - Street 1:1524 S GREEN BAY RD
Practice Address - Street 2:BACK IN ACTION/5 ELEMENTS
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-5788
Practice Address - Country:US
Practice Address - Phone:262-884-7580
Practice Address - Fax:262-884-7589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI734-055261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center