| Organization Name: | SOUTHSIDE LIFE CARE CENTER |
| NPI Number: | 1982879771 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMBERLY RYNDERS (EXECUTIVE DIRECTOR) |
| Mailing Address: | 4105 Chicago Ave Minneapolis |
| State: | MN US |
| Postal Code: | 554073144 |
| Phone Number: | 6128230301 |
| Fax Number: | 6128230775 |
| NPI Enumeration Date: | 04/23/2008 |
| NPI Last Update Date: | 04/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251V00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Voluntary or Charitable |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |