Provider Demographics
NPI:1124269808
Name:MINNESOTA SENIOR CARE, INC.
Entity type:Organization
Organization Name:MINNESOTA SENIOR CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-493-8837
Mailing Address - Street 1:361 8TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:WALNUT GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:56180-9372
Mailing Address - Country:US
Mailing Address - Phone:651-493-8837
Mailing Address - Fax:651-493-8910
Practice Address - Street 1:361 8TH ST APT 102
Practice Address - Street 2:
Practice Address - City:WALNUT GROVE
Practice Address - State:MN
Practice Address - Zip Code:56180-9372
Practice Address - Country:US
Practice Address - Phone:651-493-8837
Practice Address - Fax:651-493-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343020305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization