Provider Demographics
NPI:1104264043
Name:UPSCALE REVITALIZATION COMMUNITY DEVELOPMENT CENTER
Entity type:Organization
Organization Name:UPSCALE REVITALIZATION COMMUNITY DEVELOPMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EX. DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RIVERS
Authorized Official - Middle Name:R
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:I
Authorized Official - Credentials:D
Authorized Official - Phone:832-798-6878
Mailing Address - Street 1:4440 LEXINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2821
Mailing Address - Country:US
Mailing Address - Phone:281-208-4722
Mailing Address - Fax:281-969-8366
Practice Address - Street 1:4440 LEXINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2821
Practice Address - Country:US
Practice Address - Phone:281-208-4722
Practice Address - Fax:281-969-8366
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPSCALE REVITALIZATION COMMUNITY DEVELOPMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home