Provider Demographics
NPI:1831638972
Name:ELEVATED SOCIETY, INC
Entity Type:Organization
Organization Name:ELEVATED SOCIETY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CNSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-462-1907
Mailing Address - Street 1:20295 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2550
Mailing Address - Country:US
Mailing Address - Phone:305-974-4426
Mailing Address - Fax:
Practice Address - Street 1:20295 NW 2ND AVE SUITE 302
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-2550
Practice Address - Country:US
Practice Address - Phone:305-974-4426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management