MEDICARE: ELYSIUM ELEVATED HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	251J00000X	Nursing Care Agency
3	251E00000X	Home Health Agency
4	251F00000X	Home Infusion Agency
5	251G00000X	Community Based Hospice Care Agency
6	385H00000X	Respite Care
7	343900000X	Non-emergency Medical Transport (VAN)
8	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1164218590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELYSIUM ELEVATED HOME CARE LLC

Provider Business Mailing Address
First Line	:	7951 W BEARDSLEY RD UNIT 15203
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-2746
Country	:	US
Telephone Number	:	773-947-4649
Fax Number	:

Provider Business Practice Location Address
First Line	:	7951 W BEARDSLEY RD UNIT 15203
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-2746
Country	:	US
Telephone Number	:	773-947-4649
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS SHANAE BAINES
Credential	:	RN
Telephone Number	:	773-947-4649

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	04/21/2026

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