Healthcare Provider Details

I. General information

NPI: 1073771523
Provider Name (Legal Business Name): LIVING SERVICES FOUNDATION WINSTED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 4TH ST N
WINSTED MN
55395-4523
US

IV. Provider business mailing address

900 LONG LAKE RD SUITE 130
NEW BRIGHTON MN
55112-6428
US

V. Phone/Fax

Practice location:
  • Phone: 320-485-2151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number339827
License Number StateMN

VIII. Authorized Official

Name: JENNIFER KAMSTRA
Title or Position: SECRETARY OF THE BOARD
Credential:
Phone: 763-231-0410