MEDICARE: ELEVATED ARTS ACADEMY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2	347E00000X	Transportation Broker
3	376J00000X	Homemaker
4	385H00000X	Respite Care
5	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1376212001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATED ARTS ACADEMY LLC

Provider Business Mailing Address
First Line	:	936 ELKTON DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3536
Country	:	US
Telephone Number	:	720-366-2566
Fax Number	:

Provider Business Practice Location Address
First Line	:	936 ELKTON DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3536
Country	:	US
Telephone Number	:	720-366-2566
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PAULETTE MILLS
Credential	:
Telephone Number	:	720-366-2566

Provider Enumeration Date	:	09/07/2021
Last Update Date	:	09/07/2021

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