Provider Demographics
NPI:1861264863
Name:ELEVATED CARE MO
Entity type:Organization
Organization Name:ELEVATED CARE MO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDLOW
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC, CCDP-D, MARS
Authorized Official - Phone:573-664-1326
Mailing Address - Street 1:764 WEBER RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3317
Mailing Address - Country:US
Mailing Address - Phone:573-664-1326
Mailing Address - Fax:573-664-1328
Practice Address - Street 1:764 WEBER RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3317
Practice Address - Country:US
Practice Address - Phone:573-664-1326
Practice Address - Fax:573-664-1328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty