=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144759267
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL WELL LIVING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 W LAKE MARY BLVD STE 107
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-3501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-434-1557
-----------------------------------------------------
Fax | 407-264-6544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 W LAKE MARY BLVD STE 107
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-3501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-434-1557
-----------------------------------------------------
Fax | 407-264-6544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MISS ABBAS MUKHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-589-2369
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL13017
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------