Provider Demographics
NPI:1518508365
Name:UP NORTH ANGELS LLC
Entity type:Organization
Organization Name:UP NORTH ANGELS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:OEVERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-905-3662
Mailing Address - Street 1:28276 149TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEBEKA
Mailing Address - State:MN
Mailing Address - Zip Code:56477-3002
Mailing Address - Country:US
Mailing Address - Phone:320-905-3662
Mailing Address - Fax:218-414-2722
Practice Address - Street 1:28276 149TH AVE
Practice Address - Street 2:
Practice Address - City:SEBEKA
Practice Address - State:MN
Practice Address - Zip Code:56477-3002
Practice Address - Country:US
Practice Address - Phone:320-905-3662
Practice Address - Fax:218-414-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN393972Other393972