Healthcare Provider Details

I. General information

NPI: 1548009806
Provider Name (Legal Business Name): UPSIDEHOM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E LAS OLAS BLVD FL 14
FORT LAUDERDALE FL
33301-2299
US

IV. Provider business mailing address

200 E LAS OLAS BLVD FL 14
FORT LAUDERDALE FL
33301-2299
US

V. Phone/Fax

Practice location:
  • Phone: 954-231-4119
  • Fax:
Mailing address:
  • Phone: 954-231-4119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER BADGLEY
Title or Position: COO
Credential:
Phone: 954-231-4119