Healthcare Provider Details

I. General information

NPI: 1932774114
Provider Name (Legal Business Name): ELEVATED COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10434 BLUEGRASS ST
FIRESTONE CO
80504-4516
US

IV. Provider business mailing address

PO BOX 373
LONGMONT CO
80502-0373
US

V. Phone/Fax

Practice location:
  • Phone: 720-256-5191
  • Fax:
Mailing address:
  • Phone: 720-256-5191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: NICOLE R NEWSOM
Title or Position: FOUNDER
Credential:
Phone: 720-256-5191