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NPI Code Detail

MEDICARE: ELEVATE LIFE FAMILY SERVICES, LLC

MEDICARE: ELEVATE LIFE FAMILY SERVICES, 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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568725935
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELEVATE LIFE FAMILY SERVICES, LLC
Provider Business Mailing Address
First Line : 2605 RAINBOW GLOW ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-3709
Country : US
Telephone Number : 702-630-5009
Fax Number :
Provider Business Practice Location Address
First Line : 2605 RAINBOW GLOW ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-3709
Country : US
Telephone Number : 702-630-5009
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. WILLIE PEARL JACKSON
Credential :
Telephone Number : 702-630-5009
Provider Enumeration Date : 06/20/2012
Last Update Date : 06/20/2012

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Directions to “ELEVATE LIFE FAMILY SERVICES, LLC ” Practice Location

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