Healthcare Provider Details

I. General information

NPI: 1790426039
Provider Name (Legal Business Name): LIFEWAYCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 W 129TH ST
SAVAGE MN
55378-1514
US

IV. Provider business mailing address

4730 W 129TH ST
SAVAGE MN
55378-1514
US

V. Phone/Fax

Practice location:
  • Phone: 612-293-8808
  • Fax: 612-662-4175
Mailing address:
  • Phone: 612-366-9066
  • Fax: 612-662-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EMMANUEL AYODELE AGUDA
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 612-366-9066