Healthcare Provider Details

I. General information

NPI: 1215404769
Provider Name (Legal Business Name): LIVEN COMMUNITY CARE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 NEWBURN CT
BEAUMONT CA
92223-3131
US

IV. Provider business mailing address

PO BOX 86
BEAUMONT CA
92223-0086
US

V. Phone/Fax

Practice location:
  • Phone: 951-505-9889
  • Fax:
Mailing address:
  • Phone: 951-505-9889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND CHU
Title or Position: PRESIDENT
Credential:
Phone: 951-505-9889