Healthcare Provider Details

I. General information

NPI: 1871144725
Provider Name (Legal Business Name): UPWARD HEALTH OF LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 S CLAIBORNE AVE STE 537
NEW ORLEANS LA
70125-4142
US

IV. Provider business mailing address

188 VALLEY ST STE 201
PROVIDENCE RI
02909-2468
US

V. Phone/Fax

Practice location:
  • Phone: 888-985-5455
  • Fax:
Mailing address:
  • Phone: 888-985-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTAL LONG
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 888-985-5455