Basic Information
| Provider Information | |||||||||
| NPI: | 1437570991 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELEVATE HOME HEALTH, LLC | ||||||||
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| OtherOrganizationName: | HOME CARE SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27071 ALISO CREEK RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ALISO VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926565327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493491200 | ||||||||
| FaxNumber: | 9493491122 | ||||||||
| Practice Location | |||||||||
| Address1: | 6202 CONSTITUTION DR | ||||||||
| Address2: | SUITE C | ||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468041583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604592917 | ||||||||
| FaxNumber: | 2604592894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2013 | ||||||||
| LastUpdateDate: | 12/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | SPARKS | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 9493491200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 06-004060-1 | IN | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 200491120A | 05 | IN | MEDICAID |