Healthcare Provider Details

I. General information

NPI: 1851796304
Provider Name (Legal Business Name): ELEVATE SENIORS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10320 W MCDOWELL RD STE N1444
AVONDALE AZ
85392-4879
US

IV. Provider business mailing address

10320 W MCDOWELL RD SUITE N1444
AVONDALE AZ
85392-4863
US

V. Phone/Fax

Practice location:
  • Phone: 866-888-7078
  • Fax:
Mailing address:
  • Phone: 480-398-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. WALTER N SIMMONS
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD, MPH, FACEP
Phone: 480-398-5555