Healthcare Provider Details

I. General information

NPI: 1184505042
Provider Name (Legal Business Name): ELEVATED HEALING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 JOHN ADAMS PKWY STE 101
IDAHO FALLS ID
83401-4300
US

IV. Provider business mailing address

427 SUNTERRA DR
IDAHO FALLS ID
83404-5090
US

V. Phone/Fax

Practice location:
  • Phone: 208-716-5063
  • Fax: 866-661-4322
Mailing address:
  • Phone: 630-364-8144
  • Fax: 866-661-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN BIRD
Title or Position: MANAGER
Credential:
Phone: 630-364-8144