Provider Demographics
NPI:1114609575
Name:ELEVATION HOME HEALTHCARE SERVICE CORPORATION
Entity Type:Organization
Organization Name:ELEVATION HOME HEALTHCARE SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:SIMPSON
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-301-8305
Mailing Address - Street 1:5615 BROOKLYN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3086
Mailing Address - Country:US
Mailing Address - Phone:763-316-4128
Mailing Address - Fax:763-312-2299
Practice Address - Street 1:5937 COLFAX AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2736
Practice Address - Country:US
Practice Address - Phone:678-301-8305
Practice Address - Fax:763-312-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility