Healthcare Provider Details

I. General information

NPI: 1104235662
Provider Name (Legal Business Name): C. UPSHAW & ASSOCIATES CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 16TH ST
ECORSE MI
48229-1357
US

IV. Provider business mailing address

4020 16TH ST
ECORSE MI
48229-1357
US

V. Phone/Fax

Practice location:
  • Phone: 734-444-4985
  • Fax:
Mailing address:
  • Phone: 734-444-4985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number4704255523
License Number StateMI

VIII. Authorized Official

Name: MR. CHRISTOPHER ANDREA UPSHAW SR.
Title or Position: PRESIDENT
Credential: RN, MSN
Phone: 734-444-4985