Provider Demographics
NPI:1427345347
Name:UPTOWN FS, LLC
Entity type:Organization
Organization Name:UPTOWN FS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:DELBERT
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-303-7515
Mailing Address - Street 1:4311 OAK LAWN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2315
Mailing Address - Country:US
Mailing Address - Phone:972-303-7500
Mailing Address - Fax:972-303-9700
Practice Address - Street 1:300 S HIGHWAY 36 BYP N
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-2764
Practice Address - Country:US
Practice Address - Phone:254-865-8275
Practice Address - Fax:254-865-6344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5091314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001004431Medicaid
TX675201Medicare Oscar/Certification