Provider Demographics
NPI:1487939138
Name:LIFE'S COMPANION P.C.A., INC.
Entity type:Organization
Organization Name:LIFE'S COMPANION P.C.A., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROHDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-786-3439
Mailing Address - Street 1:10307 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-8026
Mailing Address - Country:US
Mailing Address - Phone:763-786-3439
Mailing Address - Fax:763-783-3528
Practice Address - Street 1:10307 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-8026
Practice Address - Country:US
Practice Address - Phone:763-786-3439
Practice Address - Fax:763-783-3528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA696845700Medicaid