Healthcare Provider Details

I. General information

NPI: 1205779212
Provider Name (Legal Business Name): ELEVATED HEALTH AND COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 2ND ST FL 2
SACRAMENTO CA
95814-3234
US

IV. Provider business mailing address

208 KINSELLA CT
ROSEVILLE CA
95747-9173
US

V. Phone/Fax

Practice location:
  • Phone: 646-575-8200
  • Fax:
Mailing address:
  • Phone: 646-575-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY K MARTIN
Title or Position: EXECUTIVE DIRECTOR
Credential: CERTIFIED CHW
Phone: 646-575-8200