Provider Demographics
NPI:1255424115
Name:LONG TERM CARE SPECIALISTS INC
Entity type:Organization
Organization Name:LONG TERM CARE SPECIALISTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:LETICH
Authorized Official - Suffix:
Authorized Official - Credentials:LHNA LSW
Authorized Official - Phone:612-529-9152
Mailing Address - Street 1:512 49TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-3621
Mailing Address - Country:US
Mailing Address - Phone:612-529-7747
Mailing Address - Fax:612-607-5821
Practice Address - Street 1:512 49TH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55430-3621
Practice Address - Country:US
Practice Address - Phone:612-529-7747
Practice Address - Fax:612-607-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330896314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245544Medicare Oscar/Certification