MEDICARE: MINNESOTA SENIOR CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	343020	MN

General Provider Information

NPI Number	:	1124269808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINNESOTA SENIOR CARE, INC.

Provider Business Mailing Address
First Line	:	361 8TH ST APT 102
Second Line	:
City	:	WALNUT GROVE
State	:	MN
Zip	:	56180-9372
Country	:	US
Telephone Number	:	651-493-8837
Fax Number	:	651-493-8910

Provider Business Practice Location Address
First Line	:	361 8TH ST APT 102
Second Line	:
City	:	WALNUT GROVE
State	:	MN
Zip	:	56180-9372
Country	:	US
Telephone Number	:	651-493-8837
Fax Number	:	651-493-8910

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KAO LOR
Credential	:
Telephone Number	:	651-493-8837

Provider Enumeration Date	:	03/10/2009
Last Update Date	:	03/10/2009

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