Provider Demographics
NPI:1295379154
Name:LIFESPARK HOSPICE, LLC
Entity Type:Organization
Organization Name:LIFESPARK HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR COMPLIANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-286-1150
Mailing Address - Street 1:5320 W 23RD ST STE 130
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1670
Mailing Address - Country:US
Mailing Address - Phone:952-737-4350
Mailing Address - Fax:952-737-4351
Practice Address - Street 1:5320 W 23RD ST STE 130
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1670
Practice Address - Country:US
Practice Address - Phone:952-737-4350
Practice Address - Fax:952-737-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based