Provider Demographics
NPI:1003674961
Name:ELEVATE HEALTHCARE LLC LABS
Entity Type:Organization
Organization Name:ELEVATE HEALTHCARE LLC LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:HOLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC LPN MSW
Authorized Official - Phone:719-696-9027
Mailing Address - Street 1:PO BOX 291
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-0291
Mailing Address - Country:US
Mailing Address - Phone:719-696-9027
Mailing Address - Fax:
Practice Address - Street 1:212 W 13TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3754
Practice Address - Country:US
Practice Address - Phone:719-696-9027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELEVATE HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone