Healthcare Provider Details

I. General information

NPI: 1174139422
Provider Name (Legal Business Name): ELEVATION BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 BRUNSTON CT
WESTLAKE VILLAGE CA
91362-5130
US

IV. Provider business mailing address

28632 ROADSIDE DR STE 235
AGOURA HILLS CA
91301-6095
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 Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KRISTA LYNN DENNIS
Title or Position: INSURANCE MANAGER
Credential:
Phone: 805-579-3537