Healthcare Provider Details

I. General information

NPI: 1982969069
Provider Name (Legal Business Name): LIVINGWELL HOME HEALTHCARE AGENCY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 SAWGRASS PARKWAY 4 FLOOR
SUNRISE FL
33023
US

IV. Provider business mailing address

1560 SAWGRASS CORPORATE PKWY FOURTH FLOOR
SUNRISE FL
33323-2858
US

V. Phone/Fax

Practice location:
  • Phone: 954-290-7515
  • Fax: 954-252-2158
Mailing address:
  • Phone: 954-284-8425
  • 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: MRS. ZONA MCPHERSON-VINCENT
Title or Position: MANAGER
Credential:
Phone: 954-290-7515