MEDICARE: LIFELINE CARE CENTER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1942094727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE CARE CENTER

Provider Business Mailing Address
First Line	:	2817 ANTHONY LN S STE 207
Second Line	:
City	:	SAINT ANTHONY
State	:	MN
Zip	:	55418-2490
Country	:	US
Telephone Number	:	952-564-8000
Fax Number	:	952-800-0125

Provider Business Practice Location Address
First Line	:	2817 ANTHONY LN S STE 207
Second Line	:
City	:	SAINT ANTHONY
State	:	MN
Zip	:	55418-2490
Country	:	US
Telephone Number	:	952-564-8000
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE/OWNER
Name	:	AHMED AHMED
Credential	:
Telephone Number	:	952-564-8000

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	10/30/2025

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