MEDICARE: LIVINGSPRING HEALTH AND WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	261QH0100X	Health Service Clinic/Center
3	324500000X	Substance Abuse Rehabilitation Facility
4	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1134809429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVINGSPRING HEALTH AND WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	12401 ROCKSIDE RD UNIT 25171
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-7307
Country	:	US
Telephone Number	:	216-854-2013
Fax Number	:

Provider Business Practice Location Address
First Line	:	5706 TURNEY RD STE 300
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-3928
Country	:	US
Telephone Number	:	216-854-2013
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ANTHONIA NDALI CHUKWUDELUNZU
Credential	:	FNP
Telephone Number	:	216-854-2013

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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