Healthcare Provider Details

I. General information

NPI: 1700962842
Provider Name (Legal Business Name): UPLIFT COMPREHENSIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 STERLINGWORTH ST
WINDSOR NC
27983-1724
US

IV. Provider business mailing address

PO BOX 1123
WINDSOR NC
27983-1123
US

V. Phone/Fax

Practice location:
  • Phone: 252-794-3834
  • Fax: 252-794-3204
Mailing address:
  • Phone: 252-794-3834
  • Fax: 252-794-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number8300452
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8300452
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: MR. JOHN TAYLOR
Title or Position: CO-OWNER/CFO
Credential:
Phone: 919-270-0694