Provider Demographics
NPI:1356090229
Name:PROJECT ELEVATION ENTERPRISE
Entity Type:Organization
Organization Name:PROJECT ELEVATION ENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:MR
Authorized Official - First Name:TYRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-632-7022
Mailing Address - Street 1:2113 CONCORD DR APT C
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-4616
Mailing Address - Country:US
Mailing Address - Phone:757-632-7022
Mailing Address - Fax:
Practice Address - Street 1:2113 CONCORD DR APT C
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-4616
Practice Address - Country:US
Practice Address - Phone:757-632-7022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROJECT ELEVATION ENTERPRISE GLOBAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty