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General NPI Number Information
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NPI Number | 1962845537
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Entity Type | Organization
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Legal Business Name | LIFESTYLE ADULT DAY CENTER, LLC
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Dates
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Enumeration Date | 04/12/2013
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Last Update Date | 04/12/2013
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Provider Practice Location Address
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Address Line | 7089 10TH ST N
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City | OAKDALE
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State | MN
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Zip | 55128-5938
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Country | US
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Telephone | 651-731-5154
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Fax | 651-714-9182
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Provider Business Mailing Address
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Address Line | 7089 10TH ST N
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City | OAKDALE
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State | MN
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Zip | 55128-5938
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Country | US
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Telephone | 651-731-5154
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Fax | 651-714-9182
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Authorized Official
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Title or Position | OFFICER/MEMBER ORGANIZER
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Name | MR. MIKE YANG
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Credential |
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Telephone | 651-247-1737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 1064601-1-ADC
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License Number State | MN
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