Provider Demographics
NPI:1609449610
Name:UPTOP RESIDENTIAL LLC
Entity Type:Organization
Organization Name:UPTOP RESIDENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEMEAL
Authorized Official - Middle Name:DESHAWN
Authorized Official - Last Name:NESMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-560-8137
Mailing Address - Street 1:101 BOWMAN DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-2362
Mailing Address - Country:US
Mailing Address - Phone:757-560-8137
Mailing Address - Fax:
Practice Address - Street 1:365 GARRISON PL
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5436
Practice Address - Country:US
Practice Address - Phone:757-340-0204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health