Healthcare Provider Details

I. General information

NPI: 1548074347
Provider Name (Legal Business Name): LIVASSIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 LINDELL BLVD STE 300
SAINT LOUIS MO
63108-3725
US

IV. Provider business mailing address

2550 W UNION HILLS DR STE 350
PHOENIX AZ
85027-5187
US

V. Phone/Fax

Practice location:
  • Phone: 866-448-6565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: WALTER THOMAS WHITE
Title or Position: ENTITY
Credential:
Phone: 866-448-6565