Provider Demographics
NPI:1538945654
Name:LIFT UP A CHILD
Entity type:Organization
Organization Name:LIFT UP A CHILD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSCOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-787-8725
Mailing Address - Street 1:15374 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1519
Mailing Address - Country:US
Mailing Address - Phone:313-686-9845
Mailing Address - Fax:
Practice Address - Street 1:15374 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1519
Practice Address - Country:US
Practice Address - Phone:313-686-9845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable