Provider Demographics
NPI:1407627144
Name:ELEVATION ELDERCARE, INC.
Entity Type:Organization
Organization Name:ELEVATION ELDERCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:LOSERIC
Authorized Official - Last Name:FOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-235-2258
Mailing Address - Street 1:1851 KIOWA AVE # 1113
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-2461
Mailing Address - Country:US
Mailing Address - Phone:928-235-2258
Mailing Address - Fax:
Practice Address - Street 1:1813 AMBAS DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-7445
Practice Address - Country:US
Practice Address - Phone:928-235-2258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility