Healthcare Provider Details

I. General information

NPI: 1003802505
Provider Name (Legal Business Name): LIFECARE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 DELMORE DR
ROSEAU MN
56751-1534
US

IV. Provider business mailing address

715 DELMORE DR
ROSEAU MN
56751-1534
US

V. Phone/Fax

Practice location:
  • Phone: 218-463-2500
  • Fax: 218-463-4782
Mailing address:
  • Phone: 218-463-2500
  • Fax: 218-463-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMN

VIII. Authorized Official

Name: CATHERINE A. HUSS
Title or Position: CFO
Credential:
Phone: 218-463-4763