MEDICARE: LIFETIME CARE AT HOME

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	174400000X	Specialist

General Provider Information

NPI Number	:	1396976171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME CARE AT HOME

Provider Business Mailing Address
First Line	:	W 7652 2090TH AVENUE
Second Line	:
City	:	HAGER CITY
State	:	WI
Zip	:	54014
Country	:	US
Telephone Number	:	612-636-0751
Fax Number	:

Provider Business Practice Location Address
First Line	:	W 7652 2090TH AVENUE
Second Line	:
City	:	HAGAR CITY
State	:	WI
Zip	:	54014
Country	:	US
Telephone Number	:	612-636-0751
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MICHAEL FERDINAND BAUER
Credential	:
Telephone Number	:	612-636-0751

Provider Enumeration Date	:	07/28/2009
Last Update Date	:	07/28/2009

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Directions to “LIFETIME CARE AT HOME ” Practice Location

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