Provider Demographics
NPI:1073106092
Name:ELEVATED EXCELLENCE
Entity Type:Organization
Organization Name:ELEVATED EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OPERATING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIARIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-799-7919
Mailing Address - Street 1:17231 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-4632
Mailing Address - Country:US
Mailing Address - Phone:708-799-7919
Mailing Address - Fax:
Practice Address - Street 1:17231 COVENTRY LN
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-4632
Practice Address - Country:US
Practice Address - Phone:708-799-7919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care