Healthcare Provider Details

I. General information

NPI: 1720690811
Provider Name (Legal Business Name): ELEVATE RECOVERY PROJECT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7742 OFFICE PARK BLVD STE C2
BATON ROUGE LA
70809-8636
US

IV. Provider business mailing address

10771 PERKINS RD STE C
BATON ROUGE LA
70810-1693
US

V. Phone/Fax

Practice location:
  • Phone: 225-270-8068
  • Fax: 225-960-5851
Mailing address:
  • Phone: 225-270-8068
  • Fax: 225-960-5851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DONALD W POPE JR.
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 225-270-8068