Healthcare Provider Details

I. General information

NPI: 1982764932
Provider Name (Legal Business Name): LIVING WELL HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 PARKWAY DR
SAINT CLAIR MO
63077-2438
US

IV. Provider business mailing address

1351 PARKWAY DR
SAINT CLAIR MO
63077-2438
US

V. Phone/Fax

Practice location:
  • Phone: 636-629-9994
  • Fax: 636-629-9945
Mailing address:
  • Phone: 636-629-9994
  • Fax: 636-629-9945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0007754
License Number StateMO

VIII. Authorized Official

Name: PHYLLIS J BRIGGS
Title or Position: DIRECTOR - MEDICAL SERVICES
Credential:
Phone: 636-629-9994