MEDICARE: ELEVATED PLACES BEHAVIORAL HEALTH

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
1	251S00000X	Community/Behavioral Health Agency	E0234592018-5	NV

General Provider Information

NPI Number	:	1477048296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATED PLACES BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	4108 BOSTON BELL CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3684
Country	:	US
Telephone Number	:	414-718-2033
Fax Number	:

Provider Business Practice Location Address
First Line	:	4108 BOSTON BELL CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3684
Country	:	US
Telephone Number	:	414-218-7033
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. AMIRAH BROWN
Credential	:
Telephone Number	:	414-218-7033

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	09/27/2018

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