Provider Demographics
NPI:1184322380
Name:ELEVATIONS GROUP HOME AND INDEPENDENT LIVING
Entity type:Organization
Organization Name:ELEVATIONS GROUP HOME AND INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-203-0311
Mailing Address - Street 1:PO BOX 5823
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-0823
Mailing Address - Country:US
Mailing Address - Phone:856-203-0311
Mailing Address - Fax:
Practice Address - Street 1:71 STUART ST
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3228
Practice Address - Country:US
Practice Address - Phone:856-379-7110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care