Provider Demographics
NPI:1134920036
Name:ELEVATE BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:ELEVATE BEHAVIORAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALVASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-437-8167
Mailing Address - Street 1:3350 SHELBY STREET
Mailing Address - Street 2:SUITE 200 #1005
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764
Mailing Address - Country:US
Mailing Address - Phone:951-437-8167
Mailing Address - Fax:
Practice Address - Street 1:3350 SHELBY STREET
Practice Address - Street 2:SUITE 200 #1005
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764
Practice Address - Country:US
Practice Address - Phone:951-437-8167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-24
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty