Provider Demographics
NPI:1407130248
Name:DIRECTIONS FOR LIFE PCA SERVICES, LLC
Entity Type:Organization
Organization Name:DIRECTIONS FOR LIFE PCA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MEILACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-722-1184
Mailing Address - Street 1:4897 MILLER TRUNK HWY STE 226
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1584
Mailing Address - Country:US
Mailing Address - Phone:218-722-1184
Mailing Address - Fax:218-727-3677
Practice Address - Street 1:4897 MILLER TRUNK HWY STE 226
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-1584
Practice Address - Country:US
Practice Address - Phone:218-722-1184
Practice Address - Fax:218-727-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN354301251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health