Provider Demographics
NPI:1669684817
Name:LIFESPAN HOME CARE SERVICES INC.
Entity type:Organization
Organization Name:LIFESPAN HOME CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AKPENE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ASEMPA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:651-210-7122
Mailing Address - Street 1:93 LITTLE CANADA RD W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1683
Mailing Address - Country:US
Mailing Address - Phone:651-765-6034
Mailing Address - Fax:651-765-2873
Practice Address - Street 1:93 LITTLE CANADA RD W
Practice Address - Street 2:SUITE 103
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55117-1683
Practice Address - Country:US
Practice Address - Phone:651-765-6034
Practice Address - Fax:651-765-2873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN798102000251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1669684817OtherNPI
MN798102000OtherMHCP