Provider Demographics
NPI:1427432962
Name:ELEVATE SENIORS
Entity type:Organization
Organization Name:ELEVATE SENIORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:214-558-8730
Mailing Address - Street 1:406 CLAYTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3322
Mailing Address - Country:US
Mailing Address - Phone:214-558-8730
Mailing Address - Fax:
Practice Address - Street 1:1452 HUGHES RD
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7366
Practice Address - Country:US
Practice Address - Phone:817-873-5105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236933305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service