Healthcare Provider Details

I. General information

NPI: 1992507396
Provider Name (Legal Business Name): UPLIFT HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3149 JEFFERSON AVE
EAST SAINT LOUIS IL
62205-1447
US

IV. Provider business mailing address

3149 JEFFERSON AVE
EAST SAINT LOUIS IL
62205-1447
US

V. Phone/Fax

Practice location:
  • Phone: 319-300-0095
  • Fax: 319-300-0095
Mailing address:
  • Phone: 319-300-0095
  • Fax: 319-300-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NEEMA JOHN MUSHI
Title or Position: OWNER/CEO
Credential:
Phone: 319-300-0095