Healthcare Provider Details

I. General information

NPI: 1104272004
Provider Name (Legal Business Name): ELEVATED TECHNOLOGIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 5TH AVE S
CRAIG CO
81625-9418
US

IV. Provider business mailing address

1051 5TH AVE S
CRAIG CO
81625-9418
US

V. Phone/Fax

Practice location:
  • Phone: 970-824-4677
  • Fax: 970-824-4677
Mailing address:
  • Phone: 970-824-4677
  • Fax: 970-824-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier57680051
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: RONAL MORGAN HATCHER
Title or Position: OWNER
Credential:
Phone: 970-379-4677