Provider Demographics
NPI:1508324401
Name:E.L.E.V.A.T.E
Entity Type:Organization
Organization Name:E.L.E.V.A.T.E
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAMUNO
Authorized Official - Middle Name:
Authorized Official - Last Name:IMBU
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:612-272-6659
Mailing Address - Street 1:3835 WASHBURN AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-1822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:616 E 25TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3704
Practice Address - Country:US
Practice Address - Phone:612-353-5065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management