MEDICARE: ELEVATE DREAMZ 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
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1912840190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE DREAMZ LLC

Provider Business Mailing Address
First Line	:	3065A W 159TH ST
Second Line	:
City	:	MARKHAM
State	:	IL
Zip	:	60428-4003
Country	:	US
Telephone Number	:	312-818-6793
Fax Number	:	312-546-9731

Provider Business Practice Location Address
First Line	:	11433 S VINCENNES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4315
Country	:	US
Telephone Number	:	312-819-6793
Fax Number	:	312-546-9731

Authorized Official
Title or Position	:	OWNER
Name	:	LATANYA FRAZIER
Credential	:
Telephone Number	:	312-819-6793

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “ELEVATE DREAMZ LLC ” Practice Location

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