MEDICARE: LIVING WELL MANAGEMENT, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility
2	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34545	OTHER	FL	AHCA

General Provider Information

NPI Number	:	1134782154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING WELL MANAGEMENT, INC

Provider Business Mailing Address
First Line	:	8725 NW 18TH TER STE 102
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33172-2629
Country	:	US
Telephone Number	:	305-342-8736
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 W COMMERCIAL BLVD STE 21
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3320
Country	:	US
Telephone Number	:	954-909-0407
Fax Number	:	954-909-0408

Authorized Official
Title or Position	:	CEO
Name	:	JOEL ALEJO QUINTERO
Credential	:
Telephone Number	:	305-342-8736

Provider Enumeration Date	:	04/16/2019
Last Update Date	:	10/06/2021

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