Provider Demographics
NPI:1073796322
Name:LIFE SENIOR CARE INC.
Entity Type:Organization
Organization Name:LIFE SENIOR CARE INC.
Other - Org Name:LIFE SENIOR CARE PCPO
Other - Org Type:Other Name
Authorized Official - Title/Position:RN CARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGERY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VETSCH-PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:763-350-6369
Mailing Address - Street 1:8503 178TH LN NE
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-8351
Mailing Address - Country:US
Mailing Address - Phone:651-464-6167
Mailing Address - Fax:
Practice Address - Street 1:28347 112TH ST NW
Practice Address - Street 2:
Practice Address - City:ZIMMERMAN
Practice Address - State:MN
Practice Address - Zip Code:55398-4307
Practice Address - Country:US
Practice Address - Phone:763-350-6369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health