Provider Demographics
NPI:1437346434
Name:LIFENET, LLC
Entity Type:Organization
Organization Name:LIFENET, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:FRESLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-835-4111
Mailing Address - Street 1:PO BOX 1081
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54702
Mailing Address - Country:US
Mailing Address - Phone:715-835-4111
Mailing Address - Fax:715-835-4359
Practice Address - Street 1:800 WISCONSIN ST STE 305
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-3588
Practice Address - Country:US
Practice Address - Phone:715-835-4111
Practice Address - Fax:715-835-4359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI335251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43108100Medicaid