Provider Demographics
NPI:1104517465
Name:UPSIDE LIVING
Entity type:Organization
Organization Name:UPSIDE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/ OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:PARCENUE
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:727-492-2237
Mailing Address - Street 1:2119 LITTLE BROOK LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-2416
Mailing Address - Country:US
Mailing Address - Phone:727-492-2237
Mailing Address - Fax:
Practice Address - Street 1:2119 LITTLE BROOK LN
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-2416
Practice Address - Country:US
Practice Address - Phone:727-492-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home