Healthcare Provider Details

I. General information

NPI: 1568387439
Provider Name (Legal Business Name): ELEVATION RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19322 103RD AVENUE CT E
GRAHAM WA
98338-6445
US

IV. Provider business mailing address

522 W RIVERSIDE AVE
SPOKANE WA
99201-0580
US

V. Phone/Fax

Practice location:
  • Phone: 253-356-6500
  • Fax:
Mailing address:
  • Phone: 206-949-2297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAMETRA LYNTHIA BOLAR
Title or Position: SUBSTANCE USE DISORDER PROFESIONAL
Credential: SUDP
Phone: 206-949-2297