Provider Demographics
NPI:1811446883
Name:UPLIFT SUPPORT SERVICES
Entity type:Organization
Organization Name:UPLIFT SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-803-0315
Mailing Address - Street 1:4415 FLORIDA NATIONAL DR STE 108
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1567
Mailing Address - Country:US
Mailing Address - Phone:813-803-0315
Mailing Address - Fax:
Practice Address - Street 1:4415 FLORIDA NATIONAL DR STE 108
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1567
Practice Address - Country:US
Practice Address - Phone:813-803-0315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL16000017965251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management