Healthcare Provider Details

I. General information

NPI: 1497679435
Provider Name (Legal Business Name): LIVEWELL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 COUNTY ROAD B W STE 108
ROSEVILLE MN
55113-4107
US

IV. Provider business mailing address

1611 COUNTY ROAD B W STE 108
ROSEVILLE MN
55113-4107
US

V. Phone/Fax

Practice location:
  • Phone: 651-472-4840
  • Fax:
Mailing address:
  • Phone: 651-472-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: YER YANG
Title or Position: CEO
Credential:
Phone: 651-366-7293