MEDICARE: LIFESPACE COMMUNITIES INC

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	314000000X	Skilled Nursing Facility	332203	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NH0298	OTHER	MN	UCARE
2	71-22549	OTHER	MN	MEDICA
3	8773FR	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1588606461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESPACE COMMUNITIES INC

Provider Business Mailing Address
First Line	:	8100 HIGHWOOD DR
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55438-1020
Country	:	US
Telephone Number	:	952-831-7500
Fax Number	:	952-830-9893

Provider Business Practice Location Address
First Line	:	8100 HIGHWOOD DR
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55438-1020
Country	:	US
Telephone Number	:	952-831-7500
Fax Number	:	952-830-9893

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. SCOTT MICHAEL HARRISON
Credential	:
Telephone Number	:	515-288-5805

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	05/04/2010

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Directions to “LIFESPACE COMMUNITIES INC ” Practice Location

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