Provider Demographics
NPI:1295499648
Name:UPLIFT 100 LLC
Entity type:Organization
Organization Name:UPLIFT 100 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PA
Authorized Official - Middle Name:MUSA
Authorized Official - Last Name:NYANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-671-3855
Mailing Address - Street 1:2365 APOLLO ST
Mailing Address - Street 2:924
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6332
Mailing Address - Country:US
Mailing Address - Phone:914-671-3855
Mailing Address - Fax:
Practice Address - Street 1:5212 VILLAGE CREEK DR # A
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5066
Practice Address - Country:US
Practice Address - Phone:972-773-9610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care