1225045362 NPI number — LIFETRACK RESOURCES, INC.

Table of content: (NPI 1225045362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225045362 NPI number — LIFETRACK RESOURCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFETRACK RESOURCES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. PAUL REHABILITATION CENTER
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225045362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
709 UNIVERSITY AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55104-4804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-227-8471
Provider Business Mailing Address Fax Number:
651-265-2318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
709 UNIVERSITY AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55104-4804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-227-8471
Provider Business Practice Location Address Fax Number:
651-265-2318
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLBERG
Authorized Official First Name:
TRIXIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
651-227-8471

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1019353 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 119905 . This is a "CHOICE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 13112SP . This is a "BCBS - OT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 995555101 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27779PA . This is a "BCBS - PT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5900058 . This is a "MEDICA DUAL SOLUTION" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 553476300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431M9LI . This is a "BCBS - MENTAL HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 995555100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102486 . This is a "UCARE - PT/OT/SP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 108931 . This is a "UCARE - MENTAL HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 505120046 . This is a "MHP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 28605PA . This is a "BCBS - SP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6400054 . This is a "MEDICA CROSS OVER MEDICAR" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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