Provider Demographics
NPI:1891497590
Name:ELEVATE CARE CLINIC LLC
Entity Type:Organization
Organization Name:ELEVATE CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVILL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:812-251-4873
Mailing Address - Street 1:4160 N PRIVATE ROAD 220 E
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-8354
Mailing Address - Country:US
Mailing Address - Phone:812-251-4873
Mailing Address - Fax:
Practice Address - Street 1:503 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2502
Practice Address - Country:US
Practice Address - Phone:812-251-4873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care