Provider Demographics
NPI:1457006660
Name:ELIVATE WELLNESS LLC
Entity Type:Organization
Organization Name:ELIVATE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN
Authorized Official - Phone:502-338-2561
Mailing Address - Street 1:2222 MOUNT CARMEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON JUNCTION
Mailing Address - State:KY
Mailing Address - Zip Code:40150-8269
Mailing Address - Country:US
Mailing Address - Phone:502-338-2561
Mailing Address - Fax:
Practice Address - Street 1:1707 CEDAR GROVE RD
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-8572
Practice Address - Country:US
Practice Address - Phone:502-338-2561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care