Provider Demographics
NPI:1194138529
Name:UPWARD CHANGE HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:UPWARD CHANGE HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-422-3036
Mailing Address - Street 1:807 E MAIN ST STE 2120
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4099
Mailing Address - Country:US
Mailing Address - Phone:919-682-5300
Mailing Address - Fax:919-682-5322
Practice Address - Street 1:2302 W MEADOWVIEW RD
Practice Address - Street 2:SUITE 109
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3721
Practice Address - Country:US
Practice Address - Phone:336-852-0092
Practice Address - Fax:336-852-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302603Medicaid