Healthcare Provider Details

I. General information

NPI: 1659299899
Provider Name (Legal Business Name): ELEVATE YOUTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4524 BROOKLINE RD
SYLVANIA OH
43560-3301
US

IV. Provider business mailing address

4524 BROOKLINE RD
SYLVANIA OH
43560-3301
US

V. Phone/Fax

Practice location:
  • Phone: 419-309-7880
  • Fax:
Mailing address:
  • Phone: 419-309-7880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CORNELIUS JWAUN CRAWFORD
Title or Position: CEO
Credential: MD
Phone: 419-309-7880