Healthcare Provider Details

I. General information

NPI: 1962018366
Provider Name (Legal Business Name): UPLIFT FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5023 LANNOO ST
GROSSE POINTE MI
48236-2158
US

IV. Provider business mailing address

5023 LANNOO ST
GROSSE POINTE MI
48236-2158
US

V. Phone/Fax

Practice location:
  • Phone: 313-820-1939
  • Fax:
Mailing address:
  • Phone: 313-820-1939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: EMILY PARKS
Title or Position: OWNER
Credential: LLMSW
Phone: 313-820-1939