Provider Demographics
NPI:1861628455
Name:DIRECTIONS FOR LIFE PCA SERVICES
Entity Type:Organization
Organization Name:DIRECTIONS FOR LIFE PCA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE PROGRAM COORDINATOR, QMRP
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
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
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1586
Mailing Address - Country:US
Mailing Address - Phone:218-722-1184
Mailing Address - Fax:218-722-7148
Practice Address - Street 1:4897 MILLER TRUNK HWY
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-1586
Practice Address - Country:US
Practice Address - Phone:218-722-1184
Practice Address - Fax:218-722-7148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA111290200Medicaid