Loon Lake Living Care Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

LOON LAKE LIVING CARE INC

Practice address

400 Ford Rd Apt 215
Saint Louis Park, MN 55426-1012

Phone

(615) 308-2668

NPI assigned

Mar 15, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dek A Haji

Title

Manager

Phone

(615) 308-2668

Specialties & licenses 1

Addresses

Other names 1

• Loon Lake Living Care INC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1741996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741996800000",
    "number": "1508666983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 FORD RD APT 215",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554261012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 FORD RD APT 215",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554261012",
            "telephone_number": "615-308-2668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOON LAKE LIVING CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-15",
        "last_updated": "2025-03-15",
        "certification_date": "2025-03-15",
        "status": "A",
        "authorized_official_last_name": "HAJI",
        "authorized_official_first_name": "DEK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "615-308-2668"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Loon Lake Living Care INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa R Livingston, OTR/L
• Mark Lobanoff, M.D.
• Kaitlyn Locker
• George Logan
• William Gerald Loomis, D.C.
• Sarah Loots, CRNA
• Jayme Lopuch, LICSW
• Ian McKenzie Lorang, MD
• Jaime Loso, M.D.
• Jay Loso, PT

• Home Health Agency in Saint Louis Park, MN
• Providers in Saint Louis Park, MN by specialty
• Home Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.