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NPI Code Detail

MEDICARE: ELEVATE LLC

MEDICARE: ELEVATE LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1437719523
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELEVATE LLC
Provider Business Mailing Address
First Line : 3111 BROAD ST
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-8342
Country : US
Telephone Number : 206-552-6724
Fax Number : 206-456-1889
Provider Business Practice Location Address
First Line : 3111 BROAD ST
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-8342
Country : US
Telephone Number : 206-552-6724
Fax Number : 206-456-1889
Authorized Official
Title or Position : MANAGING MEMBER
Name : MR. NEILL DORN
Credential :
Telephone Number : 206-552-6724
Provider Enumeration Date : 06/19/2019
Last Update Date : 06/21/2019

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Directions to “ELEVATE LLC ” Practice Location

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