Healthcare Provider Details

I. General information

NPI: 1679248686
Provider Name (Legal Business Name): ELEVATED HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 03/19/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 26TH AVE STE 306
GULFPORT MS
39501-1951
US

IV. Provider business mailing address

PO BOX 4095
GULFPORT MS
39502-4095
US

V. Phone/Fax

Practice location:
  • Phone: 228-343-3306
  • Fax:
Mailing address:
  • Phone: 228-343-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. AMESHA BARNES
Title or Position: OWNER
Credential:
Phone: 228-343-3306