Healthcare Provider Details

I. General information

NPI: 1356162341
Provider Name (Legal Business Name): UPLIFT SOBRIETY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7139 WOODLEY AVE
VAN NUYS CA
91406-3932
US

IV. Provider business mailing address

7139 WOODLEY AVE
VAN NUYS CA
91406-3932
US

V. Phone/Fax

Practice location:
  • Phone: 909-461-0960
  • Fax:
Mailing address:
  • Phone: 909-461-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL CONNARD
Title or Position: CEO
Credential:
Phone: 909-461-0960