MEDICARE: UPLIFT DEVELOPMENT CORPORATION

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	251E00000X	Home Health Agency	O15990	TX

General Provider Information

NPI Number	:	1861864399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPLIFT DEVELOPMENT CORPORATION

Provider Business Mailing Address
First Line	:	6636 BELLFORT ST
Second Line	:	6636 BELFORT SUITE OFFICE
City	:	HOUSTON
State	:	TX
Zip	:	77087-6407
Country	:	US
Telephone Number	:	832-832-8687
Fax Number	:

Provider Business Practice Location Address
First Line	:	6636 BELLFORT ST
Second Line	:	6636 BELFORT SUITE OFFICE
City	:	HOUSTON
State	:	TX
Zip	:	77087-6407
Country	:	US
Telephone Number	:	832-832-8687
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	. RODNEY UNDERWOOD
Credential	:
Telephone Number	:	832-868-7219

Provider Enumeration Date	:	10/23/2015
Last Update Date	:	10/23/2015

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