MEDICARE: UPLIFT COMPREHENSIVE SERVICES

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	MHL-066-012	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MHL-066-012	OTHER	NC	DAYTREATMENT LICENSE

General Provider Information

NPI Number	:	1871655753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPLIFT COMPREHENSIVE SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 31
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-0031
Country	:	US
Telephone Number	:	919-270-0694
Fax Number	:

Provider Business Practice Location Address
First Line	:	8380 HIGHWAY 305 SOUTH
Second Line	:
City	:	JACKSON
State	:	NC
Zip	:	27845-9674
Country	:	US
Telephone Number	:	252-794-3834
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JOHN TAYLOR
Credential	:
Telephone Number	:	919-270-0694

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	08/22/2020

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