Provider Demographics
NPI:1861189789
Name:CLUB UPLIFTED, INC
Entity type:Organization
Organization Name:CLUB UPLIFTED, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-272-5768
Mailing Address - Street 1:30 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3602
Mailing Address - Country:US
Mailing Address - Phone:734-272-5768
Mailing Address - Fax:734-879-0562
Practice Address - Street 1:30 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-3602
Practice Address - Country:US
Practice Address - Phone:734-272-5768
Practice Address - Fax:734-879-0562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services