| Lifesource Of North Carolina | |
|
725 2nd Ave S Hopkins MN 55343-7782 | |
| (910) 742-9243 | |
| (888) 746-1787 |
| Full Name | Lifesource Of North Carolina |
|---|---|
| Speciality | Social Worker |
| Location | 725 2nd Ave S, Hopkins, Minnesota |
| Authorized Official Name and Position | Peggy Baddour (PRESIDENT) |
| Authorized Official Contact | 9107779165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Of North Carolina Po Box 538622 Atlanta GA 30353-8622 Ph: (910) 742-9243 | Lifesource Of North Carolina 725 2nd Ave S Hopkins MN 55343-7782 Ph: (910) 742-9243 |
| NPI Number | 1801431127 |
|---|---|
| Provider Enumeration Date | 11/11/2019 |
| Last Update Date | 03/26/2021 |
| Certification Date | 03/26/2021 |
| Medicare PECOS PAC ID | 7416132428 |
|---|---|
| Medicare Enrollment ID | O20200819002156 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801431127 | NPI | - | NPPES |
| Provider Name | Lisa Rasheed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538371687 PECOS PAC ID: 7911276464 Enrollment ID: I20200819002303 |
| Provider Name | Jenna Margaret Murphy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689243792 PECOS PAC ID: 7214332527 Enrollment ID: I20210825001803 |
| Provider Name | Tasha Oladipo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568958635 PECOS PAC ID: 5092127555 Enrollment ID: I20210913002291 |
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