Healthcare Provider Details

I. General information

NPI: 1043158553
Provider Name (Legal Business Name): ELEVATE SENIOR HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 YANKEE ST UNIT 111
SPEARFISH SD
57783-5706
US

IV. Provider business mailing address

120 YANKEE ST UNIT 111
SPEARFISH SD
57783-5706
US

V. Phone/Fax

Practice location:
  • Phone: 605-349-2636
  • Fax: 605-460-8908
Mailing address:
  • Phone: 605-349-2636
  • Fax: 605-460-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELSEY NYLANDER
Title or Position: OWNER
Credential: DO
Phone: 605-349-2636