Elevate Premier Support Inc

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

ELEVATE PREMIER SUPPORT INC

Practice address

1332 Londontown Blvd Ste 115H
Eldersburg, MD 21784-6587

Phone

(443) 627-1654

NPI assigned

Oct 3, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Morufu Fagbenro, OWNER

Title

Director

Phone

(443) 627-1654

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696291200000",
    "number": "1134909609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1332 LONDONTOWN BLVD STE 115H",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217846587",
            "telephone_number": "443-627-1654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1332 LONDONTOWN BLVD STE 115H",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217846587",
            "telephone_number": "443-627-1654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATE PREMIER SUPPORT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-03",
        "last_updated": "2023-10-03",
        "certification_date": "2023-09-29",
        "status": "A",
        "authorized_official_last_name": "FAGBENRO",
        "authorized_official_first_name": "MORUFU",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "443-627-1654",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Eldersburg, MD
• Providers in Eldersburg, MD by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.