Healthcare Provider Details

I. General information

NPI: 1265674899
Provider Name (Legal Business Name): LIVINGWELL HOME HEALTHCARE SERVICES OF VA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 03/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6802 PARAGON PL SUITE 410
RICHMOND VA
23230-1644
US

IV. Provider business mailing address

PO BOX 6591
RICHMOND VA
23230-0591
US

V. Phone/Fax

Practice location:
  • Phone: 866-489-4191
  • Fax: 866-896-3091
Mailing address:
  • Phone: 866-489-4191
  • Fax: 866-496-3091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS HOFLER
Title or Position: REGIONAL ADMINISTRATOR
Credential:
Phone: 866-489-4191