UPLIFT COMPREHENSIVE SERVICES - NPI NUMBER 1962698621

Summary

Provider Name: UPLIFT COMPREHENSIVE SERVICES

NPI Number: 1962698621

Clasification: Counselor (101Y00000X)

Address:
312 STERLINGWORTH ST
WINDSOR, NC
ZIP 27983

Phone Number: (252) 794-3834



Detailed Information

UPLIFT COMPREHENSIVE SERVICES is a counselor in Windsor, NC. The provider is a provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master�s degree and clinical experience and supervision for licensure or certification. The assigned NPI number for this provider is 1962698621 and is registered as an organization entity type and is a multi-specialty group.

The provider's business address is:

312 STERLINGWORTH ST
WINDSOR, NC
ZIP 27983-724
Phone: (252) 794-3834
Fax: (242) 793-3204

The provider's authorized official is John Taylor .
The authorized official title is Cfo and has the following contact phone number (252) 334-1536.

The enumeration date for this NPI number is 9/17/2007 and was last updated on 9/17/2007.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 101Y00000X Counselor Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 8300650G MEDICAID NC

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1962698621 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name UPLIFT COMPREHENSIVE SERVICES The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 312 STERLINGWORTH ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name WINDSOR The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name NC The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 279831724 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 2527943834 The telephone number associated with the location address of the provider being identified.
11 Provider Business Practice Location Address Fax Number 2427933204 The fax number associated with the location address of the provider being identified.
12 Provider Enumeration Date 9/17/2007 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 9/17/2007 The date that a record was last updated or changed.
14 Authorized Official Last Name TAYLOR The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name JOHN The first name of the authorized official.
16 Authorized Official Title or Position CFO The title or position of the authorized official.
17 Authorized Official Telephone Number 2523341536 The 10-position telephone number of the authorized official.
18 Healthcare Provider Taxonomy Code 1 101Y00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Healthcare Provider Primary Taxonomy Switch 1 Y
20 Other Provider Identifier 1 8300650G Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
21 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
22 Other Provider Identifier State 1 NC
23 Is Organization Subpart N
24 Authorized Official Name Prefix Text MR.
25 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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