Healthcare Provider Details

I. General information

NPI: 1740724491
Provider Name (Legal Business Name): UPLIFTED CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 BROOKDALE DR N
BROOKLYN PARK MN
55443-2863
US

IV. Provider business mailing address

3340 BROOKDALE DR N
BROOKLYN PARK MN
55443-2863
US

V. Phone/Fax

Practice location:
  • Phone: 763-280-3236
  • Fax: 888-588-3166
Mailing address:
  • Phone: 763-280-3236
  • Fax: 888-588-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number379763
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number379763
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number379763
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number379763
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number379763
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number379763
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number379763
License Number StateMN
# 8
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number379763
License Number StateMN
# 9
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number379763
License Number StateMN
# 10
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number379763
License Number StateMN
# 11
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number379763
License Number StateMN

VIII. Authorized Official

Name: MR. WILLIAM AKUMA
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 612-978-7620