=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407130248
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIRECTIONS FOR LIFE PCA SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2011
-----------------------------------------------------
Last Update Date | 09/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4897 MILLER TRUNK HWY STE 226
-----------------------------------------------------
City | HERMANTOWN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55811-1584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-722-1184
-----------------------------------------------------
Fax | 218-727-3677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4897 MILLER TRUNK HWY STE 226
-----------------------------------------------------
City | HERMANTOWN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55811-1584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-722-1184
-----------------------------------------------------
Fax | 218-727-3677
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MISS CHRISTINE LYNN MEILACH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 218-722-1184
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 354301
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------