Provider Demographics
NPI:1023431616
Name:LIFESTONE HEALTH CARE, INC.
Entity type:Organization
Organization Name:LIFESTONE HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHIAMAKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ENEMUOH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:218-481-7306
Mailing Address - Street 1:2214 SPRINGVALE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3159
Mailing Address - Country:US
Mailing Address - Phone:218-481-7306
Mailing Address - Fax:218-481-7306
Practice Address - Street 1:2214 SPRINGVALE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-3159
Practice Address - Country:US
Practice Address - Phone:218-481-7306
Practice Address - Fax:218-481-7306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-02
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29862251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health