Provider Demographics
NPI:1437570991
Name:ELEVATE HOME HEALTH, LLC
Entity Type:Organization
Organization Name:ELEVATE HOME HEALTH, LLC
Other - Org Name:HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-349-1200
Mailing Address - Street 1:27071 ALISO CREEK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5327
Mailing Address - Country:US
Mailing Address - Phone:949-349-1200
Mailing Address - Fax:949-349-1122
Practice Address - Street 1:6202 CONSTITUTION DR
Practice Address - Street 2:SUITE C
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1583
Practice Address - Country:US
Practice Address - Phone:260-459-2917
Practice Address - Fax:260-459-2894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06-004060-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200491120AMedicaid
IN157556Medicare Oscar/Certification