Provider Demographics
NPI:1497492482
Name:UPLIFT BEHAVIORAL
Entity Type:Organization
Organization Name:UPLIFT BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YESSENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:823-716-9191
Mailing Address - Street 1:1500 E DESERT INN RD STE 4
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2550
Mailing Address - Country:US
Mailing Address - Phone:702-405-6163
Mailing Address - Fax:702-405-6492
Practice Address - Street 1:1500 E DESERT INN RD STE 4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2550
Practice Address - Country:US
Practice Address - Phone:702-405-6163
Practice Address - Fax:702-405-6492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20222443817Medicaid