Healthcare Provider Details

I. General information

NPI: 1942497086
Provider Name (Legal Business Name): UPSCALE RESIDENTIAL CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 NORTH MAPLE PLACE
ROSEBORO NC
28382
US

IV. Provider business mailing address

PO BOX 1051
ROSEBORO NC
28382-1051
US

V. Phone/Fax

Practice location:
  • Phone: 919-789-1154
  • Fax: 866-786-3576
Mailing address:
  • Phone: 919-789-1154
  • Fax: 866-786-3576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2565
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5467
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9145
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32077
License Number StateSC
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNC

VIII. Authorized Official

Name: VENDIA CURRIE
Title or Position: CEO
Credential:
Phone: 919-789-1154