MEDICARE: LIVELIHOOD WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1427665298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVELIHOOD WELLNESS LLC

Provider Business Mailing Address
First Line	:	2655 E DEER SPRINGS WAY APT 1029
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1451
Country	:	US
Telephone Number	:	702-720-7029
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 E DEER SPRINGS WAY APT 1029
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1451
Country	:	US
Telephone Number	:	702-720-7029
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ALFONSO RAFEKY BROOKS JR.
Credential	:
Telephone Number	:	702-720-7029

Provider Enumeration Date	:	09/25/2020
Last Update Date	:	09/25/2020

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