{
"Npi": {
"NPI": "1114055902",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LIVE WELL HOME CARE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "520 W BROADWAY AVE",
"SecondLineMailingAddress": "SUITE 201",
"MailingAddressCityName": "BROKEN ARROW",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "74012-3882",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "918-710-5013",
"MailingAddressFaxNumber": "918-994-6289",
"FirstLinePracticeLocationAddress": "520 W BROADWAY AVE",
"SecondLinePracticeLocationAddress": "SUITE 201",
"PracticeLocationAddressCityName": "BROKEN ARROW",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "74012-3882",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "918-710-5013",
"PracticeLocationAddressFaxNumber": "918-994-6289",
"EnumerationDate": "03/01/2007",
"LastUpdateDate": "03/12/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BEELER",
"AuthorizedOfficialFirstName": "BEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "918-289-5650",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "7029",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}