Healthcare Provider Details

I. General information

NPI: 1487507448
Provider Name (Legal Business Name): LIVING WELL COMMUNITY HOUSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9706 KENNEDY
CLEVELAND OH
44104-0000
US

IV. Provider business mailing address

9706 KENNEDY
CLEVELAND OH
44104-0000
US

V. Phone/Fax

Practice location:
  • Phone: 216-399-1286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PORSHA HALL
Title or Position: SSA
Credential:
Phone: 216-399-1286