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General NPI Number Information
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NPI Number | 1154258028
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Entity Type | Organization
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Legal Business Name | LIFEWAYCARE INC
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Dates
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Enumeration Date | 05/06/2026
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Last Update Date | 05/06/2026
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Provider Practice Location Address
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Address Line | 1681 COUNTY ROAD C E
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1193
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Country | US
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Telephone | 612-366-9066
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Fax | 612-662-4175
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Provider Business Mailing Address
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Address Line | 4730 W 129TH ST
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City | SAVAGE
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State | MN
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Zip | 55378-1514
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Country | US
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Telephone | 612-366-9066
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EMMANUEL AGUDA
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Credential |
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Telephone | 612-366-9066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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