Healthcare Provider Details

I. General information

NPI: 1982445334
Provider Name (Legal Business Name): UPTOP COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CENTERVILLE RD
LITTLE CANADA MN
55117-1105
US

IV. Provider business mailing address

3000 CENTERVILLE RD
LITTLE CANADA MN
55117-1105
US

V. Phone/Fax

Practice location:
  • Phone: 651-968-0543
  • Fax: 651-390-6033
Mailing address:
  • Phone: 651-968-0543
  • Fax: 651-390-6033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. KO REH
Title or Position: OWNER
Credential:
Phone: 651-968-0543