Healthcare Provider Details

I. General information

NPI: 1104650357
Provider Name (Legal Business Name): ELEVATED SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 4TH ST STE 3
HUNTINGDON PA
16652-1421
US

IV. Provider business mailing address

PO BOX 38
HOLLIDAYSBURG PA
16648-0038
US

V. Phone/Fax

Practice location:
  • Phone: 814-810-3902
  • Fax:
Mailing address:
  • Phone: 814-810-3902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MADELINE SELL
Title or Position: OWNER
Credential: LPC
Phone: 814-810-3902