Healthcare Provider Details

I. General information

NPI: 1972051480
Provider Name (Legal Business Name): LIVEFULLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 71ST AVE STE 104
GREELEY CO
80634-9782
US

IV. Provider business mailing address

361 71ST AVE STE 104
GREELEY CO
80634-9782
US

V. Phone/Fax

Practice location:
  • Phone: 970-515-5025
  • Fax: 970-515-5320
Mailing address:
  • Phone: 970-515-5025
  • Fax: 970-515-5320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BRIAN WILSON
Title or Position: OWNER / MANAGER
Credential:
Phone: 720-724-0416