Healthcare Provider Details

I. General information

NPI: 1295499648
Provider Name (Legal Business Name): UPLIFT 100 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5212 VILLAGE CREEK DR # A
PLANO TX
75093-5066
US

IV. Provider business mailing address

2365 APOLLO ST 924
GARLAND TX
75044-6332
US

V. Phone/Fax

Practice location:
  • Phone: 972-773-9610
  • Fax: 972-863-9686
Mailing address:
  • Phone: 914-671-3855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: PA MUSA NYANG
Title or Position: OPERATIONS
Credential:
Phone: 914-671-3855