Provider Demographics
NPI:1114795531
Name:UPLIFTING JOURNEY LLC
Entity Type:Organization
Organization Name:UPLIFTING JOURNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ESPOIR
Authorized Official - Middle Name:
Authorized Official - Last Name:NTEZEYOMBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-299-1254
Mailing Address - Street 1:319 SE 162ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-3807
Mailing Address - Country:US
Mailing Address - Phone:623-299-1254
Mailing Address - Fax:
Practice Address - Street 1:421 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1803
Practice Address - Country:US
Practice Address - Phone:781-354-8094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)