Provider Demographics
NPI:1376277244
Name:ELEVATE & EVOLVE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ELEVATE & EVOLVE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCED
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:862-235-8736
Mailing Address - Street 1:1706 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-5473
Mailing Address - Country:US
Mailing Address - Phone:862-235-8736
Mailing Address - Fax:
Practice Address - Street 1:1706 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5473
Practice Address - Country:US
Practice Address - Phone:862-235-8736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)