=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528985967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | B2 ELEVATED INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2026
-----------------------------------------------------
Last Update Date | 07/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1840 JOHN MUIR PKWY
-----------------------------------------------------
City | HERCULES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94547-2790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-612-5019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1840 JOHN MUIR PKWY
-----------------------------------------------------
City | HERCULES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94547-2790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-612-5019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | BRYAN BISHOP
-----------------------------------------------------
Credential | CSP, OHST
-----------------------------------------------------
Telephone | 510-612-5019
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------