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General NPI Number Information
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NPI Number | 1386950939
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Entity Type | Organization
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Legal Business Name | LIVITUP, INC
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 3239 PLAYERS CLUB PARKWAY
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City | MEMPHIS
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State | TN
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Zip | 38125
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Country | US
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Telephone | 901-761-4277
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Fax | 901-761-7876
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Provider Business Mailing Address
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Address Line | PO BOX 381167
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City | GERMANTOWN
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State | TN
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Zip | 38183
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Country | US
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Telephone | 901-761-4277
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Fax | 901-761-7876
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Authorized Official
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Title or Position | CEO/BOARD MEMNER
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Name | MRS. MICHAEL W NOLEN JR.
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Credential | EMT-IV, CAC
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Telephone | 901-333-1031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | L000000005751
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License Number State | TN
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