Healthcare Provider Details

I. General information

NPI: 1679715825
Provider Name (Legal Business Name): LIVEWELL HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26263 GIBRALTAR RD SUITE 600/700
FLAT ROCK MI
48134-1579
US

IV. Provider business mailing address

26263 GIBRALTAR RD SUITE 600/700
FLAT ROCK MI
48134-1579
US

V. Phone/Fax

Practice location:
  • Phone: 734-783-3636
  • Fax: 734-783-3633
Mailing address:
  • Phone: 734-783-3636
  • Fax: 734-783-3633

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: MS. LISA ANN BUFFA
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: RN
Phone: 734-783-3636