Healthcare Provider Details

I. General information

NPI: 1871128850
Provider Name (Legal Business Name): ELEVATED KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CHURCH ST
PHILADELPHIA PA
19106-2201
US

IV. Provider business mailing address

100 CREST CT
WEDDINGTON NC
28104-5626
US

V. Phone/Fax

Practice location:
  • Phone: 267-807-0550
  • Fax: 704-389-3193
Mailing address:
  • Phone: 267-807-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: AMBERLY BROOK CABALLERO
Title or Position: CEO
Credential:
Phone: 267-807-0550