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General NPI Number Information
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NPI Number | 1447938683
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Entity Type | Organization
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Legal Business Name | LIVELY VIRTUAL CARE ORGANIZATION PC
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 108 BEN EZRA AVE
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City | ROSEVILLE
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State | CA
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Zip | 95678-2702
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Country | US
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Telephone | 916-235-8617
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Fax | 916-846-9463
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Provider Business Mailing Address
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Address Line | PO BOX 604
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City | ROSEVILLE
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State | CA
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Zip | 95661-0604
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Country | US
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Telephone | 916-622-3609
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Fax | 916-333-3634
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Authorized Official
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Title or Position | CEO
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Name | SANDRA KOCSIS
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Credential | MHA
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Telephone | 916-622-3609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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