Healthcare Provider Details

I. General information

NPI: 1861380974
Provider Name (Legal Business Name): ELEVATE YOUTH RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 GRIFFIN RD
DAVIE FL
33314-4301
US

IV. Provider business mailing address

951 W YAMATO RD STE 100
BOCA RATON FL
33431-4437
US

V. Phone/Fax

Practice location:
  • Phone: 954-857-4976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: EMILY FUNKHOUSER
Title or Position: DIRECTOR
Credential:
Phone: 954-857-4976