Provider Demographics
NPI:1326716226
Name:ELEVATED HOME CARE
Entity Type:Organization
Organization Name:ELEVATED HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO /OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHAUNICE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GRIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-633-2774
Mailing Address - Street 1:9420 TOWNE SQUARE AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6910
Mailing Address - Country:US
Mailing Address - Phone:513-633-2774
Mailing Address - Fax:
Practice Address - Street 1:9420 TOWNE SQUARE AVE STE 20
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6910
Practice Address - Country:US
Practice Address - Phone:513-633-2774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care