MEDICARE: UPLIFT TREATMENT CENTER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1093541088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPLIFT TREATMENT CENTER INC.

Provider Business Mailing Address
First Line	:	17210 SAN FERNANDO MISSION BLVD
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-4159
Country	:	US
Telephone Number	:	310-674-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	17210 SAN FERNANDO MISSION BLVD
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-4159
Country	:	US
Telephone Number	:	310-674-4444
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. HRATCH JABOURIAN
Credential	:
Telephone Number	:	310-674-4444

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	09/09/2024

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