=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588539068
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVINGLIFE HEALTHCARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2025
-----------------------------------------------------
Last Update Date | 10/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18300 TYLER ST NW
-----------------------------------------------------
City | ELK RIVER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55330-4529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-999-5356
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18300 TYLER ST NW
-----------------------------------------------------
City | ELK RIVER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55330-4529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-999-5356
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DC/DM
-----------------------------------------------------
Name | EMILY MWAGA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-233-0498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------