Healthcare Provider Details

I. General information

NPI: 1285578468
Provider Name (Legal Business Name): LIVING WELL HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6724 HIGHWAY 85 STE 4
RIVERDALE GA
30274-2374
US

IV. Provider business mailing address

6724 HIGHWAY 85 STE 4
RIVERDALE GA
30274-2374
US

V. Phone/Fax

Practice location:
  • Phone: 678-608-9612
  • Fax:
Mailing address:
  • Phone: 678-608-9612
  • Fax:

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGENETTE AGAMA
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 678-608-9612