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General NPI Number Information
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NPI Number | 1033471966
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Entity Type | Organization
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Legal Business Name | LIVE WELL ALF CORP.
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 8886 NW 119TH ST
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City | HIALEAH GARDENS
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State | FL
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Zip | 33018-1986
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Country | US
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Telephone | 786-360-4455
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Fax | 866-243-4467
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Provider Business Mailing Address
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Address Line | 8886 NW 119TH ST
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City | HIALEAH GARDENS
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State | FL
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Zip | 33018-1986
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Country | US
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Telephone | 786-360-4455
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Fax | 866-243-4467
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDRES PEREZ JR.
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Credential |
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Telephone | 305-979-8085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12102
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License Number State | FL
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