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General NPI Number Information
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NPI Number | 1750250742
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Entity Type | Organization
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Legal Business Name | ELEVATE360 SERVICES LLC
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Dates
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Enumeration Date | 10/30/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 10707 CORPORATE DR STE 250
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City | STAFFORD
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State | TX
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Zip | 77477-4037
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Country | US
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Telephone | 678-677-4041
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Fax |
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Provider Business Mailing Address
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Address Line | 3627 CIBOLO CT
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City | PEARLAND
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State | TX
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Zip | 77584-3975
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Country | US
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Telephone | 678-677-4041
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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 | TYRONE LANE
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Credential | MA,
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Telephone | 678-677-4041
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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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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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