Provider Demographics
NPI:1962698621
Name:UPLIFT COMPREHENSIVE SERVICES
Entity type:Organization
Organization Name:UPLIFT COMPREHENSIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-334-1536
Mailing Address - Street 1:312 STERLINGWORTH ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-1724
Mailing Address - Country:US
Mailing Address - Phone:252-794-3834
Mailing Address - Fax:242-793-3204
Practice Address - Street 1:312 STERLINGWORTH ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-1724
Practice Address - Country:US
Practice Address - Phone:252-794-3834
Practice Address - Fax:242-793-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300650GMedicaid