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General NPI Number Information
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NPI Number | 1124949110
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Entity Type | Organization
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Legal Business Name | SERVE INSPIRE BUILD UPLIFT THERAPY LLC
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Dates
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Enumeration Date | 07/24/2026
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Last Update Date | 07/24/2026
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Provider Practice Location Address
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Address Line | 590 TANOAK ST
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City | HOLLISTER
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State | CA
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Zip | 95023-3129
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Country | US
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Telephone | 916-600-1529
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Fax |
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Provider Business Mailing Address
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Address Line | 590 TANOAK ST
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City | HOLLISTER
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State | CA
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Zip | 95023-3129
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | WILLIAM MICHAEL MARSHALL-SULLIVAN
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Credential |
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Telephone | 916-600-1529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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