Healthcare Provider Details

I. General information

NPI: 1487272357
Provider Name (Legal Business Name): LIVING WELL SENIOR CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 CABARRUS AVE W
CONCORD NC
28025-5150
US

IV. Provider business mailing address

4311 SCHOOL HOUSE CMNS # 140
HARRISBURG NC
28075-7510
US

V. Phone/Fax

Practice location:
  • Phone: 704-918-5494
  • Fax: 800-878-7151
Mailing address:
  • Phone: 704-918-5494
  • Fax: 800-878-7151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: LEKESHIA M LYNCH
Title or Position: DIRECTOR OF HEALTH AND WELLNESS
Credential: LCSW
Phone: 704-918-5494