Provider Demographics
NPI:1063883411
Name:LIFE REFINE COMPANY, INC.
Entity type:Organization
Organization Name:LIFE REFINE COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NUR
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAYID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-204-8930
Mailing Address - Street 1:6200 EXCELSIOR BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2734
Mailing Address - Country:US
Mailing Address - Phone:763-204-8930
Mailing Address - Fax:763-204-8931
Practice Address - Street 1:6200 EXCELSIOR BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-2734
Practice Address - Country:US
Practice Address - Phone:763-204-8930
Practice Address - Fax:763-204-8931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility