Provider Demographics
NPI:1306260526
Name:LIFE HEALTH CARE, INC
Entity type:Organization
Organization Name:LIFE HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GBOEAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-546-1489
Mailing Address - Street 1:2738 WINNETKA AVE N
Mailing Address - Street 2:STE 280
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2850
Mailing Address - Country:US
Mailing Address - Phone:763-546-1489
Mailing Address - Fax:763-546-1513
Practice Address - Street 1:2738 WINNETKA AVE N
Practice Address - Street 2:STE 280
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-2850
Practice Address - Country:US
Practice Address - Phone:763-546-1489
Practice Address - Fax:763-546-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1067129-1-HCBS251G00000X
MN363079251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based