Healthcare Provider Details

I. General information

NPI: 1336713791
Provider Name (Legal Business Name): ELEVATIONS SUBSTANCE ABUSE FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 LASSEN ST
NORTHRIDGE CA
91325-1023
US

IV. Provider business mailing address

18200 LASSEN ST
NORTHRIDGE CA
91325-1023
US

V. Phone/Fax

Practice location:
  • Phone: 818-914-6069
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIMOTHY MEISE
Title or Position: CEO
Credential:
Phone: 609-342-9430