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General NPI Number Information
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NPI Number | 1225305527
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Entity Type | Organization
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Legal Business Name | LIVEWELL HOME CARE INC
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 6720 PAULINE DR
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City | CHAPEL HILL
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State | NC
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Zip | 27514-9781
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Country | US
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Telephone | 919-403-6718
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 BEETHOVEN ST
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City | LOS ANGELES
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State | CA
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Zip | 90066-7061
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Country | US
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Telephone | 310-776-7082
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE OFFICER
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Name | MRS. DORIKA BECKETT
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Credential | MBA
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Telephone | 310-714-1376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL068028
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License Number State | NC
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