Provider Demographics
NPI:1134909609
Name:ELEVATE PREMIER SUPPORT INC
Entity type:Organization
Organization Name:ELEVATE PREMIER SUPPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MORUFU
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGBENRO
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:443-627-1654
Mailing Address - Street 1:1332 LONDONTOWN BLVD STE 115H
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6587
Mailing Address - Country:US
Mailing Address - Phone:443-627-1654
Mailing Address - Fax:
Practice Address - Street 1:1332 LONDONTOWN BLVD STE 115H
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6587
Practice Address - Country:US
Practice Address - Phone:443-627-1654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities