MEDICARE: LIVING WELL COMMUNITY HOUSING 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1487507448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING WELL COMMUNITY HOUSING LLC

Provider Business Mailing Address
First Line	:	9706 KENNEDY
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-0000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9706 KENNEDY
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-0000
Country	:	US
Telephone Number	:	216-399-1286
Fax Number	:

Authorized Official
Title or Position	:	SSA
Name	:	PORSHA HALL
Credential	:
Telephone Number	:	216-399-1286

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	02/19/2026

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Directions to “LIVING WELL COMMUNITY HOUSING LLC ” Practice Location

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