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General NPI Number Information
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NPI Number | 1861380974
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Entity Type | Organization
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Legal Business Name | ELEVATE YOUTH RECOVERY, LLC
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 6530 GRIFFIN RD
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City | DAVIE
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State | FL
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Zip | 33314-4301
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Country | US
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Telephone | 954-857-4976
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Fax |
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Provider Business Mailing Address
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Address Line | 951 W YAMATO RD STE 100
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City | BOCA RATON
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State | FL
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Zip | 33431-4437
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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 | DIRECTOR
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Name | EMILY FUNKHOUSER
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Credential |
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Telephone | 954-857-4976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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