Provider Demographics
NPI:1942467485
Name:LIFE CARE PCA LLC
Entity Type:Organization
Organization Name:LIFE CARE PCA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:MUSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-808-5481
Mailing Address - Street 1:17165 GAGE WAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-9227
Mailing Address - Country:US
Mailing Address - Phone:651-808-5481
Mailing Address - Fax:952-431-6160
Practice Address - Street 1:17165 GAGE WAY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-9227
Practice Address - Country:US
Practice Address - Phone:651-808-5481
Practice Address - Fax:952-431-6160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1408501-23747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty