Basic Information
Provider Information
NPI: 1548606445
EntityType: 2
ReplacementNPI:  
OrganizationName: PROJECT UPLIFT
LastName:  
FirstName:  
MiddleName:  
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NameSuffix:  
Credential:  
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Mailing Information
Address1: 1130 SELMI DR
Address2: SUITE 601
City: RENO
State: NV
PostalCode: 895126701
CountryCode: US
TelephoneNumber: 7754205396
FaxNumber: 7754205053
Practice Location
Address1: 1130 SELMI DR
Address2: SUITE 601
City: RENO
State: NV
PostalCode: 895126701
CountryCode: US
TelephoneNumber: 7754205396
FaxNumber: 7754205053
Other Information
ProviderEnumerationDate: 05/17/2013
LastUpdateDate: 05/17/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ROSS
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: GENEERAL MANAGER
AuthorizedOfficialTelephone: 7754205396
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
347C00000X  Y Transportation ServicesPrivate Vehicle 

No ID Information.


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