Provider Demographics
NPI:1669591954
Name:MINNESOTA LIFE CARE SERVICES
Entity type:Organization
Organization Name:MINNESOTA LIFE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-560-8995
Mailing Address - Street 1:7710 BROOKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2979
Mailing Address - Country:US
Mailing Address - Phone:763-560-9643
Mailing Address - Fax:763-560-9720
Practice Address - Street 1:5280 ANNAPOLIS LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3614
Practice Address - Country:US
Practice Address - Phone:763-577-1501
Practice Address - Fax:763-577-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN335308251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health