- Enrollment id
- O20060307000317
- Enrollment state
- MN
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1003802505
- Multiple npi flag
- N
- Ccn
- 247094
- Associate id
- 4789586884
- Organization name
- LIFECARE MEDICAL CENTER
- Incorporation date
- 1995-10-01
- Incorporation state
- MN
- Organization type structure
- OTHER
- Organization other type text
- NON-PROFIT ORGANIZATION
- Proprietary nonprofit
- N
- Address line 1
- 715 DELMORE DR
- City
- ROSEAU
- State
- MN
- Zip code
- 567511534