Provider Demographics
NPI:1255666939
Name:LITTLE ONES OF THE UP, LLC
Entity Type:Organization
Organization Name:LITTLE ONES OF THE UP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIHP COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COPENHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LMSW, IMH-E
Authorized Official - Phone:906-286-3254
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:GERMFASK
Mailing Address - State:MI
Mailing Address - Zip Code:49836-0023
Mailing Address - Country:US
Mailing Address - Phone:906-286-3254
Mailing Address - Fax:
Practice Address - Street 1:300 WALNUT RM 155
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854
Practice Address - Country:US
Practice Address - Phone:906-286-3254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health