Provider Demographics
NPI:1508225434
Name:UPLIFT HOMECARE LLC
Entity Type:Organization
Organization Name:UPLIFT HOMECARE LLC
Other - Org Name:INTERIM HEALTHCARE OF EAST TAMPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WADDIE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-261-0130
Mailing Address - Street 1:110 W REYNOLDS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-3377
Mailing Address - Country:US
Mailing Address - Phone:813-261-0130
Mailing Address - Fax:813-261-0603
Practice Address - Street 1:110 W REYNOLDS ST STE 101
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3377
Practice Address - Country:US
Practice Address - Phone:813-261-0130
Practice Address - Fax:813-261-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-20
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994569251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG22000096858OtherSTAE OF FLORIDA