Provider Demographics
NPI:1891294203
Name:LIFE MADE EASY HEALTHCARE L.L.C
Entity Type:Organization
Organization Name:LIFE MADE EASY HEALTHCARE L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-554-0740
Mailing Address - Street 1:7346 HAMES WAY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-4215
Mailing Address - Country:US
Mailing Address - Phone:612-554-0740
Mailing Address - Fax:612-278-2022
Practice Address - Street 1:13355 GEORGE WEBER DR STE B
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4864
Practice Address - Country:US
Practice Address - Phone:612-554-0740
Practice Address - Fax:612-278-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-2096708163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063911469OtherNPI