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General NPI Number Information
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NPI Number | 1710866934
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Entity Type | Organization
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Legal Business Name | THE ELEVARE AGENCY LLC
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Dates
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Enumeration Date | 09/01/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 11638 OLD MOUNTAIN RD
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City | GLEN ALLEN
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State | VA
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Zip | 23059-1120
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Country | US
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Telephone | 804-496-1725
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Fax |
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Provider Business Mailing Address
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Address Line | 9613 PALOMINE CT
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City | GLEN ALLEN
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State | VA
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Zip | 23060-2430
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAREEN EDWARDS
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Credential |
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Telephone | 804-496-1725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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