Healthcare Provider Details

I. General information

NPI: 1619724077
Provider Name (Legal Business Name): LIFECARE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 MAIN AVE NE
WARROAD MN
56763-2342
US

IV. Provider business mailing address

715 DELMORE DR
ROSEAU MN
56751-1599
US

V. Phone/Fax

Practice location:
  • Phone: 218-386-2020
  • Fax:
Mailing address:
  • Phone: 218-463-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE A HUSS
Title or Position: CFO
Credential:
Phone: 218-463-2500