Healthcare Provider Details

I. General information

NPI: 1649182288
Provider Name (Legal Business Name): ELEVATION SUPPORT NETWORK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 SAMBRE PL
ROSEVILLE CA
95747-6649
US

IV. Provider business mailing address

408 SAMBRE PL
ROSEVILLE CA
95747-6649
US

V. Phone/Fax

Practice location:
  • Phone: 916-284-8411
  • Fax:
Mailing address:
  • Phone: 916-284-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: YOLANDA DYCE-FOSTER
Title or Position: CEO
Credential:
Phone: 916-284-8411