MEDICARE: ELEVATE HOME HEALTH, 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	251E00000X	Home Health Agency	6271HHA-3	NV

General Provider Information

NPI Number	:	1922428739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	27071 ALISO CREEK RD
Second Line	:	SUITE 100
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-5327
Country	:	US
Telephone Number	:	949-349-1200
Fax Number	:	949-349-1122

Provider Business Practice Location Address
First Line	:	720 E CHARLESTON BLVD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-1545
Country	:	US
Telephone Number	:	702-382-3030
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	CAROL SPARKS
Credential	:
Telephone Number	:	949-349-1200

Provider Enumeration Date	:	04/18/2014
Last Update Date	:	04/18/2014

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