Provider Demographics
NPI:1538359302
Name:LIFE FORCE-CERVELLA, INC
Entity type:Organization
Organization Name:LIFE FORCE-CERVELLA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-694-7000
Mailing Address - Street 1:3555 PLYMOUTH BLVD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1389
Mailing Address - Country:US
Mailing Address - Phone:763-694-7000
Mailing Address - Fax:763-694-7116
Practice Address - Street 1:3555 PLYMOUTH BLVD
Practice Address - Street 2:SUITE 218
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1389
Practice Address - Country:US
Practice Address - Phone:763-694-7000
Practice Address - Fax:763-694-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy