Provider Demographics
NPI:1760062574
Name:ELEVATED RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:ELEVATED RECOVERY CENTER LLC
Other - Org Name:ELEVATED RECOVERY CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALMONS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:732-801-9395
Mailing Address - Street 1:1872 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2010
Mailing Address - Country:US
Mailing Address - Phone:856-315-0220
Mailing Address - Fax:
Practice Address - Street 1:1872 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2010
Practice Address - Country:US
Practice Address - Phone:856-315-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility