Provider Demographics
NPI:1689819450
Name:UPLIFT INCORPORATED
Entity Type:Organization
Organization Name:UPLIFT INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-200-1366
Mailing Address - Street 1:P.O. BOX 416
Mailing Address - Street 2:
Mailing Address - City:OCHLOCKNEE
Mailing Address - State:GA
Mailing Address - Zip Code:31773
Mailing Address - Country:US
Mailing Address - Phone:229-200-1366
Mailing Address - Fax:
Practice Address - Street 1:7752 GA HIGHWAY 133
Practice Address - Street 2:
Practice Address - City:MORVEN
Practice Address - State:GA
Practice Address - Zip Code:31773
Practice Address - Country:US
Practice Address - Phone:229-200-1366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility