Healthcare Provider Details

I. General information

NPI: 1013770924
Provider Name (Legal Business Name): LIVING WELL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 11/01/2025
Certification Date: 11/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4204 8TH ST NW UNIT 3
WASHINGTON DC
20011-7267
US

IV. Provider business mailing address

4204 8TH ST NW UNIT 3
WASHINGTON DC
20011-7267
US

V. Phone/Fax

Practice location:
  • Phone: 202-830-4088
  • Fax: 202-964-5228
Mailing address:
  • Phone: 202-830-4088
  • Fax: 202-964-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE THOMAS
Title or Position: EXECUTIVE ADMINISTRATOR
Credential:
Phone: 202-830-4088