Provider Demographics
NPI:1750736690
Name:ELEVA ENTERPRISES, LLC
Entity type:Organization
Organization Name:ELEVA ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:888-202-0446
Mailing Address - Street 1:5102 ELK LN
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8430
Mailing Address - Country:US
Mailing Address - Phone:888-202-0446
Mailing Address - Fax:956-380-6681
Practice Address - Street 1:211 N NEBRASKA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3037
Practice Address - Country:US
Practice Address - Phone:888-202-0446
Practice Address - Fax:956-380-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101721235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1841487691OtherOWNER NPI