Provider Demographics
NPI:1184315145
Name:ELEVATED HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:ELEVATED HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN-PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIRBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-377-4840
Mailing Address - Street 1:5743 LASALLE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5670
Mailing Address - Country:US
Mailing Address - Phone:316-377-4840
Mailing Address - Fax:210-477-3600
Practice Address - Street 1:5743 LASALLE WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5670
Practice Address - Country:US
Practice Address - Phone:316-377-4840
Practice Address - Fax:210-477-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty