Provider Demographics
NPI:1619107232
Name:LIVING WITH DIGNITY CENTER
Entity Type:Organization
Organization Name:LIVING WITH DIGNITY CENTER
Other - Org Name:ADULT DAY SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:FAHR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:763-205-3080
Mailing Address - Street 1:11260 QUINN ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3631
Mailing Address - Country:US
Mailing Address - Phone:612-747-0414
Mailing Address - Fax:763-205-3080
Practice Address - Street 1:11260 QUINN ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3631
Practice Address - Country:US
Practice Address - Phone:612-747-0414
Practice Address - Fax:763-205-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1051192-1-ADC251S00000X
MNLPC00616251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health