Provider Demographics
NPI:1659946051
Name:5280 ELEVATED HOME CARE LLC
Entity Type:Organization
Organization Name:5280 ELEVATED HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CALIX
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:303-717-8037
Mailing Address - Street 1:3108 W HAMPDEN AVE STE G
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-3273
Mailing Address - Country:US
Mailing Address - Phone:303-717-8037
Mailing Address - Fax:
Practice Address - Street 1:3108 W HAMPDEN AVE STE G
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-3273
Practice Address - Country:US
Practice Address - Phone:303-717-8037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000178955Medicaid