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General NPI Number Information
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NPI Number | 1063762169
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Entity Type | Organization
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Legal Business Name | LIFE INSURANCE AGENCY, INC.
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Dates
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Enumeration Date | 09/16/2012
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 2489 RICE ST STE 295 SUITE 295
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City | ROSEVILLE
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State | MN
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Zip | 55113-3738
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Country | US
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Telephone | 952-388-7128
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Fax | 800-532-1684
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Provider Business Mailing Address
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Address Line | 2489 RICE ST STE 295 SUITE 295
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City | ROSEVILLE
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State | MN
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Zip | 55113-3738
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Country | US
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Telephone | 952-388-7128
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Fax | 800-532-1684
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TUBTSHWM WASHINGTON YANG
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Credential |
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Telephone | 952-388-7128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | MN
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