Healthcare Provider Details

I. General information

NPI: 1093463952
Provider Name (Legal Business Name): UP NORTH ANGELS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28276 149TH AVE
SEBEKA MN
56477-3002
US

IV. Provider business mailing address

28276 149TH AVE
SEBEKA MN
56477-3002
US

V. Phone/Fax

Practice location:
  • Phone: 320-905-3662
  • Fax: 218-414-2722
Mailing address:
  • Phone: 320-905-3662
  • Fax: 218-414-2722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. TRACY OEVERMANN
Title or Position: OWNER
Credential:
Phone: 888-368-5788