Provider Demographics
NPI:1073771523
Name:LIVING SERVICES FOUNDATION WINSTED LLC
Entity Type:Organization
Organization Name:LIVING SERVICES FOUNDATION WINSTED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-231-0410
Mailing Address - Street 1:900 LONG LAKE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:551 4TH ST N
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:MN
Practice Address - Zip Code:55395-4523
Practice Address - Country:US
Practice Address - Phone:320-485-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
MN339827314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN734769300Medicaid
245459Medicare PIN