MEDICARE: UPLIFTED CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center	379763	MN
2	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	379763	MN
3	311Z00000X	Custodial Care Facility	379763	MN
4	311ZA0620X	Adult Care Home Facility	379763	MN
5	332U00000X	Home Delivered Meals	379763	MN
6	385H00000X	Respite Care	379763	MN
7	385HR2050X	Respite Care Camp	379763	MN
8	385HR2055X	Child Mental Illness Respite Care	379763	MN
9	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	379763	MN
10	385HR2065X	Child Physical Disabilities Respite Care	379763	MN
11	3104A0625X	Assisted Living Facility (Mental Illness)	379763	MN

General Provider Information

NPI Number	:	1740724491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPLIFTED CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	3340 BROOKDALE DR N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-2863
Country	:	US
Telephone Number	:	763-280-3236
Fax Number	:	888-588-3166

Provider Business Practice Location Address
First Line	:	3340 BROOKDALE DR N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-2863
Country	:	US
Telephone Number	:	763-280-3236
Fax Number	:	888-588-3166

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. WILLIAM AKUMA
Credential	:	MBA
Telephone Number	:	612-978-7620

Provider Enumeration Date	:	12/15/2016
Last Update Date	:	01/07/2019

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