Healthcare Provider Details

I. General information

NPI: 1821260779
Provider Name (Legal Business Name): LIVE LONG WELL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 OSPREY VILLAGE DR
AMELIA ISLAND FL
32034-4955
US

IV. Provider business mailing address

10706 SIKES PL STE 200
CHARLOTTE NC
28277-8015
US

V. Phone/Fax

Practice location:
  • Phone: 704-246-1616
  • Fax:
Mailing address:
  • Phone: 704-246-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DONALD O. THOMPSON
Title or Position: MANAGER
Credential:
Phone: 704-246-1616