NPIMap

Organization Active NPI

Elemental Healthy Aging and Wellness Center Inc.

  • Child & Adolescent Psychiatry Physician
  • Warrenville, IL
National Provider Identifier
1467817759
Registry record updated Jan 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
036103889 Issued in IL
Legal business name
ELEMENTAL HEALTHY AGING AND WELLNESS CENTER INC.
Practice address
28373 Davis Pkwy Ste 500
Warrenville, IL 60555-1437
Phone
(331) 330-9955
NPI assigned
Dec 31, 2015
Last updated
Jan 11, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Martins Adeoye, M.D.
Title
President
Phone
(708) 574-4440

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038008395 IL
Addiction Medicine (Psychiatry & Neurology) Physician 2084A0401X 336064544 IL
Addiction Psychiatry Physician 2084P0802X 336064544 IL
Child & Adolescent Psychiatry Physician 2084P0804X 036103889 IL Primary

Addresses

Primary practice location

28373 Davis Pkwy Ste 500
Warrenville, IL 60555-1437

Mailing address

28373 Davis Pkwy Ste 500
Warrenville, IL 60555-1437
Phone (331) 330-9955

Other names 1

  • Optimal Inc Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1451520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452470400000",
    "number": "1467817759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28373 DAVIS PKWY STE 500",
            "city": "WARRENVILLE",
            "state": "IL",
            "postal_code": "605551437",
            "telephone_number": "331-330-9955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28373 DAVIS PKWY STE 500",
            "city": "WARRENVILLE",
            "state": "IL",
            "postal_code": "605551437",
            "telephone_number": "331-330-9955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEMENTAL HEALTHY AGING AND WELLNESS CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-31",
        "last_updated": "2016-01-11",
        "status": "A",
        "authorized_official_last_name": "ADEOYE",
        "authorized_official_first_name": "MARTINS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-574-4440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038008395",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "IL",
            "license": "336064544",
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "IL",
            "license": "336064544",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": "036103889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optimal Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Warrenville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.