Healthcare Provider Details

I. General information

NPI: 1992737662
Provider Name (Legal Business Name): LIVEWELL ALLIANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 S MAIN ST
PLANTSVILLE CT
06479-1720
US

IV. Provider business mailing address

1261 S MAIN ST
PLANTSVILLE CT
06479-1720
US

V. Phone/Fax

Practice location:
  • Phone: 860-628-9000
  • Fax: 860-621-8083
Mailing address:
  • Phone: 860-628-9000
  • Fax: 860-621-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2093-C
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number2093-C
License Number StateCT

VIII. Authorized Official

Name: ANYA MARISSE BOUNDS
Title or Position: DIR. OF REV & REIMBURSEMENT
Credential:
Phone: 860-628-3059