Healthcare Provider Details

I. General information

NPI: 1548047681
Provider Name (Legal Business Name): ELEVATE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 CLARENCE CT
WEST BEND WI
53095-8533
US

IV. Provider business mailing address

N169W21005 MEADOW LN
JACKSON WI
53037-8622
US

V. Phone/Fax

Practice location:
  • Phone: 262-677-2216
  • Fax:
Mailing address:
  • Phone: 262-677-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY SIMON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 262-677-2216