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1225045362

NPI Code Detail

MEDICARE: LIFETRACK RESOURCES, INC.

MEDICARE: LIFETRACK RESOURCES, 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	1041C0700X	Clinical Social Worker
2	224Z00000X	Occupational Therapy Assistant
3	225100000X	Physical Therapist
4	2251P0200X	Pediatric Physical Therapist
5	225200000X	Physical Therapy Assistant
6	225X00000X	Occupational Therapist
7	235Z00000X	Speech-Language Pathologist
8	103TC2200X	Clinical Child & Adolescent Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1019353	OTHER	MN	PREFERRED ONE
2	119905	OTHER	MN	CHOICE PLUS
3	13112SP	OTHER	MN	BCBS - OT
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	27779PA	OTHER	MN	BCBS - PT
6	5900058	OTHER	MN	MEDICA DUAL SOLUTION
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	431M9LI	OTHER	MN	BCBS - MENTAL HEALTH
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	102486	OTHER	MN	UCARE - PT/OT/SP
11	108931	OTHER	MN	UCARE - MENTAL HEALTH
12	505120046	OTHER	MN	MHP
13	28605PA	OTHER	MN	BCBS - SP
14	6400054	OTHER	MN	MEDICA CROSS OVER MEDICAR

General Provider Information

NPI Number	:	1225045362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETRACK RESOURCES, INC.

Provider Business Mailing Address
First Line	:	709 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-4804
Country	:	US
Telephone Number	:	651-227-8471
Fax Number	:	651-265-2318

Provider Business Practice Location Address
First Line	:	709 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-4804
Country	:	US
Telephone Number	:	651-227-8471
Fax Number	:	651-265-2318

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TRIXIE ANN GOLBERG
Credential	:
Telephone Number	:	651-227-8471

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	05/30/2013

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Directions to “LIFETRACK RESOURCES, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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