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General NPI Number Information
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NPI Number | 1073301255
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Entity Type | Organization
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Legal Business Name | LIVINGWELL MANOR HOMES, LLC
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 1164 BRIAR DOWNS LN
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City | BURTON
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State | MI
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Zip | 48529-2224
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Country | US
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Telephone | 810-382-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 1164 BRIAR DOWNS LN
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City | BURTON
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State | MI
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Zip | 48529-2224
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Country | US
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Telephone | 810-382-1110
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CONDRELLA TYLER
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Credential | LPN
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Telephone | 810-382-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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