Provider Demographics
NPI:1871144725
Name:UPWARD HEALTH OF LOUISIANA LLC
Entity type:Organization
Organization Name:UPWARD HEALTH OF LOUISIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-985-5455
Mailing Address - Street 1:188 VALLEY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-2468
Mailing Address - Country:US
Mailing Address - Phone:888-985-5455
Mailing Address - Fax:
Practice Address - Street 1:6221 S CLAIBORNE AVE STE 537
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-4142
Practice Address - Country:US
Practice Address - Phone:888-985-5455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty