MEDICARE: LIVEWELL OPERATIONS II, INC.

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1457607475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVEWELL OPERATIONS II, INC.

Provider Business Mailing Address
First Line	:	15520 NW 2ND AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33169-6710
Country	:	US
Telephone Number	:	305-949-2626
Fax Number	:	305-705-4513

Provider Business Practice Location Address
First Line	:	15520 NW 2ND AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33169-6710
Country	:	US
Telephone Number	:	305-949-2626
Fax Number	:	305-705-4513

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YANIR SHMARYOU
Credential	:
Telephone Number	:	305-949-2626

Provider Enumeration Date	:	07/27/2012
Last Update Date	:	07/27/2012

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