Provider Demographics
NPI:1801034426
Name:LIVING SERVICES FOUNDATION/MORA, LLC
Entity type:Organization
Organization Name:LIVING SERVICES FOUNDATION/MORA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-231-0410
Mailing Address - Street 1:900 LONG LAKE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6428
Mailing Address - Country:US
Mailing Address - Phone:763-231-0410
Mailing Address - Fax:763-231-0420
Practice Address - Street 1:110 7TH ST N
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1110
Practice Address - Country:US
Practice Address - Phone:320-679-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVING SERVICES FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-04
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245291BMedicare Oscar/Certification