Healthcare Provider Details

I. General information

NPI: 1104517465
Provider Name (Legal Business Name): UPSIDE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 LITTLE BROOK LN
CLEARWATER FL
33763-2416
US

IV. Provider business mailing address

2119 LITTLE BROOK LN
CLEARWATER FL
33763-2416
US

V. Phone/Fax

Practice location:
  • Phone: 727-492-2237
  • Fax:
Mailing address:
  • Phone: 727-492-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL PARCENUE HOLMES
Title or Position: PARTNER/ OPERATOR
Credential: PARAMEDIC
Phone: 727-492-2237