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General NPI Number Information
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NPI Number | 1144039298
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Entity Type | Organization
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Legal Business Name | ELEVATE HEALTHCARE LAB LLC
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 212 W 13TH ST STE 200
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City | PUEBLO
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State | CO
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Zip | 81003-3755
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Country | US
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Telephone | 720-987-7242
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 291
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City | WINDSOR
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State | CO
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Zip | 80550-0291
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Country | US
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Telephone | 469-442-5314
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | URSULA L HOLLINS
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Credential | LCSW LAC LPN
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Telephone | 720-987-7242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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