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General NPI Number Information
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NPI Number | 1750100129
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Entity Type | Organization
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Legal Business Name | ELEVATE HEALTHCARE LLC
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 3595 E FOUNTAIN BLVD STE 245
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-7705
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Country | US
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Telephone | 719-696-9027
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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 | 719-696-9027
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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 LYNETTE HOLLINS
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Credential | LCSW, LAC LPN
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Telephone | 719-696-9027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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