Provider Demographics
NPI:1508225434
Name:UPLIFT HOMECARE LLC
Entity type:Organization
Organization Name:UPLIFT HOMECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WADDIE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-370-7817
Mailing Address - Street 1:110 W REYNOLDS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-3377
Mailing Address - Country:US
Mailing Address - Phone:813-261-0130
Mailing Address - Fax:813-261-0603
Practice Address - Street 1:110 W REYNOLDS ST STE 104
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3377
Practice Address - Country:US
Practice Address - Phone:813-261-0130
Practice Address - Fax:813-261-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-20
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 253Z00000X, 385H00000X, 385HR2055X, 251B00000X, 251F00000X
FL299994569251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No251B00000XAgenciesCase Management
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2999994569OtherFLORIDA AGENCY FOR HEALTHCARE ADMINISTRATION
FLG22000096858OtherSTAE OF FLORIDA