Organization
LIFESTYLE LIVING HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BEVERLY SUE BROWN (ADMINISTRATER)
(612) 978-2936
Entity
Organization
Contact information
Practice address
1 W LAKE ST APT 404, MINNEAPOLIS, MN 55408-3153
(612) 978-2936
Mailing address
1 W LAKE ST APT 404, MINNEAPOLIS, MN 55408-3153
(612) 978-2936
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
17067782
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9440215
STATE ID NUMBER
MN
Enumeration date
05/27/2016
Last updated
05/27/2016
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