Provider Demographics
NPI:1164949822
Name:VITA ELEVANT LLC
Entity Type:Organization
Organization Name:VITA ELEVANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEDMAN-FALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-220-7410
Mailing Address - Street 1:1420 NE 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3815
Mailing Address - Country:US
Mailing Address - Phone:818-220-7410
Mailing Address - Fax:
Practice Address - Street 1:1420 NE 21ST AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3815
Practice Address - Country:US
Practice Address - Phone:818-220-7410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty