=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992507396
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UPLIFT HOMECARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2025
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3149 JEFFERSON AVE
-----------------------------------------------------
City | EAST SAINT LOUIS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62205-1447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-300-0095
-----------------------------------------------------
Fax | 319-300-0095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3149 JEFFERSON AVE
-----------------------------------------------------
City | EAST SAINT LOUIS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62205-1447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-300-0095
-----------------------------------------------------
Fax | 319-300-0095
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | MS. NEEMA JOHN MUSHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 319-300-0095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------