Lifestyle Living Home Care LLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

17067782 Issued in MN

Legal business name

LIFESTYLE LIVING HOME CARE LLC

Practice address

1 W Lake St Apt 404
Minneapolis, MN 55408-3153

Phone

(612) 978-2936

NPI assigned

May 27, 2016

Last updated

May 27, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Beverly Sue Brown

Title

Administrater

Phone

(612) 978-2936

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1464307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464307200000",
    "number": "1912355132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 W LAKE ST APT 404",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554083153",
            "telephone_number": "612-978-2936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 W LAKE ST APT 404",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554083153",
            "telephone_number": "612-978-2936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTYLE LIVING HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-27",
        "last_updated": "2016-05-27",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "ADMINISTRATER",
        "authorized_official_telephone_number": "612-978-2936",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MN",
            "license": "17067782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ID NUMBER",
            "identifier": "9440215",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Preferred Provider Organization in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Preferred Provider Organization in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2016; 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.