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General NPI Number Information
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NPI Number | 1144734252
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Entity Type | Organization
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Legal Business Name | LIVING WELL AT HOME
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 103 RIVERSIDE AVE
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City | FLANDERS
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State | NY
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Zip | 11901-3850
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Country | US
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Telephone | 631-591-0298
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Fax | 631-740-9233
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Provider Business Mailing Address
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Address Line | PO BOX 2177
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City | RIVERHEAD
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State | NY
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Zip | 11901-0177
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Country | US
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Telephone | 631-591-0298
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Fax |
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Authorized Official
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Title or Position | RN CLINICAL COORDINATOR
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Name | SHANELL LOVETTE WOODLEY
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Credential | RN
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Telephone | 713-665-9952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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