Healthcare Provider Details

I. General information

NPI: 1225321177
Provider Name (Legal Business Name): UPWARD FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 N 59TH AVE
GLENDALE AZ
85301-7861
US

IV. Provider business mailing address

6306 N 7TH ST
PHOENIX AZ
85014-1549
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-5801
  • Fax: 602-279-0033
Mailing address:
  • Phone: 602-279-5801
  • Fax: 602-279-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA3000X
TaxonomyAugmentative Communication Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN SMITH
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 602-279-5801