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General NPI Number Information
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NPI Number | 1669928792
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Entity Type | Organization
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Legal Business Name | LIVING WELL FAMILY CARE INC
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 02/12/2019
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Provider Practice Location Address
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Address Line | 3407 W WENDOVER AVE STE C
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City | GREENSBORO
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State | NC
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Zip | 27407-1584
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Country | US
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Telephone | 336-763-6998
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Fax | 336-763-6783
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Provider Business Mailing Address
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Address Line | 3407 W WENDOVER AVE STE C
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City | GREENSBORO
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State | NC
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Zip | 27407-1584
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Country | US
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Telephone | 336-763-6998
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Fax | 336-763-6783
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY LIDE
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Credential |
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Telephone | 336-763-6998
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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 | HC4070
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License Number State | NC
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