MEDICARE: LIFEWAYCARE 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	314000000X	Skilled Nursing Facility
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1790426039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEWAYCARE INC

Provider Business Mailing Address
First Line	:	4730 W 129TH ST
Second Line	:
City	:	SAVAGE
State	:	MN
Zip	:	55378-1514
Country	:	US
Telephone Number	:	612-366-9066
Fax Number	:	612-662-4175

Provider Business Practice Location Address
First Line	:	4730 W 129TH ST
Second Line	:
City	:	SAVAGE
State	:	MN
Zip	:	55378-1514
Country	:	US
Telephone Number	:	612-293-8808
Fax Number	:	612-662-4175

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	EMMANUEL AYODELE AGUDA
Credential	:
Telephone Number	:	612-366-9066

Provider Enumeration Date	:	04/01/2022
Last Update Date	:	04/30/2026

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Directions to “LIFEWAYCARE INC ” Practice Location

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