Healthcare Provider Details

I. General information

NPI: 1104223858
Provider Name (Legal Business Name): LIVE WELL SOCIAL ADULT DAYCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S AIRMONT RD
SUFFERN NY
10901-6509
US

IV. Provider business mailing address

20 S AIRMONT RD
SUFFERN NY
10901-6509
US

V. Phone/Fax

Practice location:
  • Phone: 845-368-0714
  • Fax:
Mailing address:
  • Phone: 845-368-0714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: EMMA MEZA
Title or Position: OWNER
Credential:
Phone: 845-368-0714