MEDICARE: UPWARD CHANGE HEALTH SERVICES, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1306083688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPWARD CHANGE HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	2003 E NC HIGHWAY 54
Second Line	:	SUITE C
City	:	DURHAM
State	:	NC
Zip	:	27713-2482
Country	:	US
Telephone Number	:	919-682-5300
Fax Number	:	919-682-5322

Provider Business Practice Location Address
First Line	:	2003 E NC HIGHWAY 54
Second Line	:	SUITE C
City	:	DURHAM
State	:	NC
Zip	:	27713-2482
Country	:	US
Telephone Number	:	919-682-5300
Fax Number	:	919-682-5322

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. MISTY DAWN ALSTON
Credential	:
Telephone Number	:	919-422-3036

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	07/24/2015

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