MEDICARE: ELEVATE RECOVERY PROJECT, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	324500000X	Substance Abuse Rehabilitation Facility
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1720690811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE RECOVERY PROJECT, LLC

Provider Business Mailing Address
First Line	:	10771 PERKINS RD STE C
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-1693
Country	:	US
Telephone Number	:	225-270-8068
Fax Number	:	225-960-5851

Provider Business Practice Location Address
First Line	:	7742 OFFICE PARK BLVD STE C2
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-8636
Country	:	US
Telephone Number	:	225-270-8068
Fax Number	:	225-960-5851

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	MR. DONALD W POPE JR.
Credential	:
Telephone Number	:	225-270-8068

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	12/07/2020

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