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General NPI Number Information
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NPI Number | 1669591954
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Entity Type | Organization
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Legal Business Name | MINNESOTA LIFE CARE SERVICES
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5280 ANNAPOLIS LN N
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City | PLYMOUTH
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State | MN
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Zip | 55446-3614
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Country | US
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Telephone | 763-577-1501
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Fax | 763-577-1502
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Provider Business Mailing Address
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Address Line | 7710 BROOKLYN BLVD
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City | BROOKLYN PARK
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State | MN
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Zip | 55443-2979
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Country | US
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Telephone | 763-560-9643
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Fax | 763-560-9720
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN TARLEY
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Credential |
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Telephone | 763-560-8995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 335308
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License Number State | MN
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