Healthcare Provider Details

I. General information

NPI: 1467534784
Provider Name (Legal Business Name): UPLIFT COMPREHENSIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 AVERY ST
GREENVILLE NC
27858-1237
US

IV. Provider business mailing address

PO BOX 31
GARNER NC
27529-0031
US

V. Phone/Fax

Practice location:
  • Phone: 252-794-3834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-074-137
License Number StateNC

VIII. Authorized Official

Name: JOHN TAYLOR
Title or Position: CFO/CO-OWNER
Credential:
Phone: 919-662-9918