MEDICARE: UPLIFTUS HOMECARE AGENCY 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1881264323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPLIFTUS HOMECARE AGENCY LLC

Provider Business Mailing Address
First Line	:	1059 CASTING SPRINGS WAY
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-7963
Country	:	US
Telephone Number	:	617-401-6718
Fax Number	:

Provider Business Practice Location Address
First Line	:	1059 CASTING SPRINGS WAY
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-7963
Country	:	US
Telephone Number	:	617-401-6718
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANETTE B KEEYA
Credential	:
Telephone Number	:	617-401-6718

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	06/28/2021

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