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General NPI Number Information
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NPI Number | 1851796304
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Entity Type | Organization
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Legal Business Name | ELEVATE SENIORS PLLC
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 06/22/2015
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Provider Practice Location Address
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Address Line | 10320 W MCDOWELL RD STE N1444
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City | AVONDALE
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State | AZ
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Zip | 85392-4879
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Country | US
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Telephone | 866-888-7078
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Fax |
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Provider Business Mailing Address
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Address Line | 10320 W MCDOWELL RD SUITE N1444
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City | AVONDALE
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State | AZ
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Zip | 85392-4863
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Country | US
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Telephone | 480-398-5555
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. WALTER N SIMMONS
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Credential | MD, MPH, FACEP
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Telephone | 480-398-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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