MEDICARE: LIVE WELL COMMUNITY SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1811625734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE WELL COMMUNITY SERVICES

Provider Business Mailing Address
First Line	:	4214 N 45TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-4309
Country	:	US
Telephone Number	:	480-206-9323
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 E CAMELBACK RD STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4420
Country	:	US
Telephone Number	:	480-206-9323
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NOELLE GOUVERT
Credential	:
Telephone Number	:	480-206-9323

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	08/09/2022

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Directions to “LIVE WELL COMMUNITY SERVICES ” Practice Location

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