Provider Demographics
NPI:1063762169
Name:LIFE INSURANCE AGENCY, INC.
Entity type:Organization
Organization Name:LIFE INSURANCE AGENCY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TUBTSHWM
Authorized Official - Middle Name:WASHINGTON
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-388-7128
Mailing Address - Street 1:2489 RICE ST STE 295
Mailing Address - Street 2:SUITE 295
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3738
Mailing Address - Country:US
Mailing Address - Phone:952-388-7128
Mailing Address - Fax:800-532-1684
Practice Address - Street 1:2489 RICE ST STE 295
Practice Address - Street 2:SUITE 295
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3738
Practice Address - Country:US
Practice Address - Phone:952-388-7128
Practice Address - Fax:800-532-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-16
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251F00000X, 253Z00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No253Z00000XAgenciesIn Home Supportive Care