Provider Demographics
NPI:1225045362
Name:LIFETRACK RESOURCES, INC.
Entity type:Organization
Organization Name:LIFETRACK RESOURCES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRIXIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GOLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-227-8471
Mailing Address - Street 1:709 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4804
Mailing Address - Country:US
Mailing Address - Phone:651-227-8471
Mailing Address - Fax:651-265-2318
Practice Address - Street 1:709 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4804
Practice Address - Country:US
Practice Address - Phone:651-227-8471
Practice Address - Fax:651-265-2318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1019353OtherPREFERRED ONE
MN119905OtherCHOICE PLUS
MN13112SPOtherBCBS - OT
MN995555101Medicaid
MN27779PAOtherBCBS - PT
MN5900058OtherMEDICA DUAL SOLUTION
MN553476300Medicaid
MN431M9LIOtherBCBS - MENTAL HEALTH
MN995555100Medicaid
MN102486OtherUCARE - PT/OT/SP
MN108931OtherUCARE - MENTAL HEALTH
MN505120046OtherMHP
MN28605PAOtherBCBS - SP
MN6400054OtherMEDICA CROSS OVER MEDICAR
MN431M9LIOtherBCBS - MENTAL HEALTH
MN431M9LIOtherBCBS - MENTAL HEALTH