Healthcare Provider Details

I. General information

NPI: 1962092106
Provider Name (Legal Business Name): ELEVATE COMPREHENSIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17117 WESTHEIMER RD # 8
HOUSTON TX
77082-1259
US

IV. Provider business mailing address

17117 WESTHEIMER RD # 8
HOUSTON TX
77082-1259
US

V. Phone/Fax

Practice location:
  • Phone: 346-283-8859
  • Fax:
Mailing address:
  • Phone: 346-283-8859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DWAYNE THOMAS
Title or Position: COO
Credential:
Phone: 346-283-8859