1396222394 NPI number — ELU LLC

Table of content: (NPI 1396222394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396222394 NPI number — ELU LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELU LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELU: COUNSELING, CONSULTING, AND COACHING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396222394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 W 40TH ST UNIT 2225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37409-1379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-358-2998
Provider Business Mailing Address Fax Number:
423-405-6346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1312 SPRING CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37412-3918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-486-0774
Provider Business Practice Location Address Fax Number:
423-405-6346
Provider Enumeration Date:
07/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
COOK
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
877-358-2998

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003241099A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30017475370001 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 312029500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q047262 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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