| Elevate Housing Foundation | |
|
405 E 5th St Waterloo IA 50703-5705 | |
| (833) 370-0719 | |
| (515) 220-2272 |
| Full Name | Elevate Housing Foundation |
|---|---|
| Speciality | Clinic/Center |
| Location | 405 E 5th St, Waterloo, Iowa |
| Authorized Official Name and Position | Ilya Shulman (PRESIDENT) |
| Authorized Official Contact | 8474143847 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elevate Housing Foundation 7101 N Cicero Ave Ste 200 Lincolnwood IL 60712-2112 Ph: (224) 420-7133 | Elevate Housing Foundation 405 E 5th St Waterloo IA 50703-5705 Ph: (833) 370-0719 |
| NPI Number | 1710503982 |
|---|---|
| Provider Enumeration Date | 06/23/2020 |
| Last Update Date | 12/14/2023 |
| Certification Date | 12/14/2023 |
| Medicare PECOS PAC ID | 6002149713 |
|---|---|
| Medicare Enrollment ID | O20201106002308 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710503982 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Michelle L Mcpoland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144300740 PECOS PAC ID: 4789718248 Enrollment ID: I20100819000236 |
| Provider Name | Amber Lacina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033436480 PECOS PAC ID: 6800041849 Enrollment ID: I20130225000199 |
| Provider Name | Kristina Marie Gates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174137061 PECOS PAC ID: 0547670275 Enrollment ID: I20201106002392 |
| Provider Name | Billie Rael |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134712821 PECOS PAC ID: 4981010790 Enrollment ID: I20210302002741 |
| Provider Name | Rebecca Montville |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740835750 PECOS PAC ID: 1658760293 Enrollment ID: I20211119000873 |
| Provider Name | Matthew Lobosco |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487896148 PECOS PAC ID: 6204121395 Enrollment ID: I20220422001837 |
| Provider Name | Cassy Lensing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265016596 PECOS PAC ID: 2466837422 Enrollment ID: I20220913000395 |
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