Provider Demographics
NPI:1891780516
Name:LIFECARE MEDICAL CENTER
Entity Type:Organization
Organization Name:LIFECARE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-463-4763
Mailing Address - Street 1:715 DELMORE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEAU
Mailing Address - State:MN
Mailing Address - Zip Code:56751-1534
Mailing Address - Country:US
Mailing Address - Phone:218-463-2500
Mailing Address - Fax:218-463-4782
Practice Address - Street 1:152 5TH ST S
Practice Address - Street 2:
Practice Address - City:GREENBUSH
Practice Address - State:MN
Practice Address - Zip Code:56726-4406
Practice Address - Country:US
Practice Address - Phone:218-782-2131
Practice Address - Fax:218-782-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN346331314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNH0426OtherUCARE
MN850026600Medicaid
MN245616Medicare Oscar/Certification