Provider Demographics
NPI:1932774114
Name:ELEVATED COMMUNITIES
Entity Type:Organization
Organization Name:ELEVATED COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEWSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-256-5191
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80502-0373
Mailing Address - Country:US
Mailing Address - Phone:720-256-5191
Mailing Address - Fax:
Practice Address - Street 1:10434 BLUEGRASS ST
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-4516
Practice Address - Country:US
Practice Address - Phone:720-256-5191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services