Healthcare Provider Details

I. General information

NPI: 1255001046
Provider Name (Legal Business Name): LIVINGSTON CARESLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 SW OVERALL ST
GREENVILLE FL
32331-3312
US

IV. Provider business mailing address

173 SW OVERALL ST
GREENVILLE FL
32331-3312
US

V. Phone/Fax

Practice location:
  • Phone: 850-524-6114
  • Fax: 850-948-1710
Mailing address:
  • Phone: 185-052-4611
  • Fax: 850-948-1710

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 Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MR. ISREAL LIVINGSTON III
Title or Position: OWNER
Credential: CNA
Phone: 850-524-6114