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General NPI Number Information
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NPI Number | 1780192831
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Entity Type | Organization
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Legal Business Name | LIVINGBROOK HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 18912 KEELI LN
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-3489
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Country | US
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Telephone | 512-577-9793
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Fax |
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Provider Business Mailing Address
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Address Line | 18912 KEELI LN
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-3489
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Country | US
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Telephone | 512-577-9793
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | OSARODION PRAISE IYAMU
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Credential |
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Telephone | 512-577-9793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 802883144
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License Number State | TX
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