Healthcare Provider Details

I. General information

NPI: 1366802464
Provider Name (Legal Business Name): ELEVATION BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29816 WESTHAVEN DR
AGOURA HILLS CA
91301-3000
US

IV. Provider business mailing address

28632 ROADSIDE DR STE 170
AGOURA HILLS CA
91301-6083
US

V. Phone/Fax

Practice location:
  • Phone: 888-643-7135
  • Fax:
Mailing address:
  • Phone: 310-951-6340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190874AP
License Number StateCA

VIII. Authorized Official

Name: MR. STEVE BOOTH
Title or Position: COO/OWNER
Credential:
Phone: 818-284-6701