Provider Demographics
NPI:1659608461
Name:UPTOWN WELLNESS
Entity Type:Organization
Organization Name:UPTOWN WELLNESS
Other - Org Name:PROSPEROUS CHILDREN CHILD CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-667-7707
Mailing Address - Street 1:3612 SUNNINGDALE WAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5654
Mailing Address - Country:US
Mailing Address - Phone:919-667-7707
Mailing Address - Fax:919-687-0506
Practice Address - Street 1:212 N CORCORAN ST
Practice Address - Street 2:SUITE 216
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3210
Practice Address - Country:US
Practice Address - Phone:919-667-7707
Practice Address - Fax:919-687-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty