Provider Demographics
NPI:1619254299
Name:PROJECT UPLIFT LLC
Entity Type:Organization
Organization Name:PROJECT UPLIFT LLC
Other - Org Name:PROJECT UPLIFT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALONZO
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-379-0748
Mailing Address - Street 1:2300 HARVARD WAY # 105
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-4002
Mailing Address - Country:US
Mailing Address - Phone:775-379-0748
Mailing Address - Fax:
Practice Address - Street 1:5925 OMAHA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-8813
Practice Address - Country:US
Practice Address - Phone:775-379-0748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NVC-21011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1619008281Medicaid