Healthcare Provider Details

I. General information

NPI: 1346925583
Provider Name (Legal Business Name): ELEVATION HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 W PASSAIC AVE
RUTHERFORD NJ
07070-1923
US

IV. Provider business mailing address

249 W PASSAIC AVE
RUTHERFORD NJ
07070-1923
US

V. Phone/Fax

Practice location:
  • Phone: 908-397-3891
  • Fax:
Mailing address:
  • Phone: 908-397-3891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADERONKE RUFFINS
Title or Position: CO-OWNER
Credential:
Phone: 908-397-3891