Provider Demographics
NPI:1437719523
Name:ELEVATE LLC
Entity Type:Organization
Organization Name:ELEVATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEILL
Authorized Official - Middle Name:
Authorized Official - Last Name:DORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-552-6724
Mailing Address - Street 1:3111 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-8342
Mailing Address - Country:US
Mailing Address - Phone:206-552-6724
Mailing Address - Fax:206-456-1889
Practice Address - Street 1:3111 BROAD ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-8342
Practice Address - Country:US
Practice Address - Phone:206-552-6724
Practice Address - Fax:206-456-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty