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General NPI Number Information
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NPI Number | 1730698929
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Entity Type | Organization
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Legal Business Name | LIVING WELL ADULT LIVING
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Dates
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Enumeration Date | 09/20/2017
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Last Update Date | 09/20/2017
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Provider Practice Location Address
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Address Line | 2911 WHEELER ST
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City | BARTOW
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State | FL
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Zip | 33830-9316
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Country | US
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Telephone | 813-240-6199
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Fax |
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Provider Business Mailing Address
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Address Line | 611 POINSETTIA RD
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City | AUBURNDALE
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State | FL
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Zip | 33823-4520
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Country | US
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Telephone | 863-595-5845
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Fax |
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | MS. LOUNA MATIEU
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Credential | RN
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Telephone | 813-240-6199
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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 | RN9416352
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | RN9462914
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License Number State | FL
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