| Lifeway Health & Wellness Llc | |
|
6964 Sycamore Ct N Maple Grove MN 55369 | |
| (763) 438-3814 | |
| Not Available |
| Full Name | Lifeway Health & Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6964 Sycamore Ct N, Maple Grove, Minnesota |
| Authorized Official Name and Position | Stacy Woodard (CEO) |
| Authorized Official Contact | 7634383814 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifeway Health & Wellness Llc 3720 152nd Ln Nw Andover MN 55304-3010 Ph: (763) 438-3814 | Lifeway Health & Wellness Llc 6964 Sycamore Ct N Maple Grove MN 55369 Ph: (763) 438-3814 |
| NPI Number | 1598443723 |
|---|---|
| Provider Enumeration Date | 07/07/2023 |
| Last Update Date | 11/11/2023 |
| Medicare PECOS PAC ID | 4486004405 |
|---|---|
| Medicare Enrollment ID | O20240103000581 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598443723 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Stacy Adair Woodard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740776707 PECOS PAC ID: 4880944644 Enrollment ID: I20180829002395 |
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