Healthcare Provider Details

I. General information

NPI: 1740986496
Provider Name (Legal Business Name): LIVING WELL COMMNUTIY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 S TOWNSLEY AVE UNIT 107
SIOUX FALLS SD
57108-7640
US

IV. Provider business mailing address

7701 S TOWNSLEY AVE UNIT 107
SIOUX FALLS SD
57108-7640
US

V. Phone/Fax

Practice location:
  • Phone: 605-370-0974
  • Fax:
Mailing address:
  • Phone: 605-370-0974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: SAMSON USHA ARGO
Title or Position: PROVIDER
Credential:
Phone: 605-370-0974