Provider Demographics
NPI:1790426039
Name:LIFEWAYCARE INC
Entity Type:Organization
Organization Name:LIFEWAYCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:AYODELE
Authorized Official - Last Name:AGUDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-293-8808
Mailing Address - Street 1:4730 W 129TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-1514
Mailing Address - Country:US
Mailing Address - Phone:612-293-8808
Mailing Address - Fax:612-662-4175
Practice Address - Street 1:4730 W 129TH ST
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-1514
Practice Address - Country:US
Practice Address - Phone:612-293-8808
Practice Address - Fax:612-662-4175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health