Provider Demographics
NPI:1174233308
Name:UPSIDEHEALTHSERVICES LLC
Entity type:Organization
Organization Name:UPSIDEHEALTHSERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:IFEOMA
Authorized Official - Last Name:EDOKPAYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-521-7400
Mailing Address - Street 1:14105 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5022
Mailing Address - Country:US
Mailing Address - Phone:240-521-7400
Mailing Address - Fax:
Practice Address - Street 1:14105 CLARK AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5022
Practice Address - Country:US
Practice Address - Phone:240-521-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty