Provider Demographics
NPI:1669893715
Name:ELEVATE HOME HEALTH, LLC
Entity type:Organization
Organization Name:ELEVATE HOME HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-349-1200
Mailing Address - Street 1:201 COVINA AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-1843
Mailing Address - Country:US
Mailing Address - Phone:800-880-1405
Mailing Address - Fax:866-379-7509
Practice Address - Street 1:201 COVINA AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-1843
Practice Address - Country:US
Practice Address - Phone:800-880-1405
Practice Address - Fax:866-379-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000481251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08407FMedicaid
CA058407Medicare Oscar/Certification