MEDICARE: LIVE WELL HOME CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1558047100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE WELL HOME CARE LLC

Provider Business Mailing Address
First Line	:	141 N ROADRUNNER PKWY STE 141
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-2000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 N ROADRUNNER PKWY STE 141
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-2000
Country	:	US
Telephone Number	:	915-247-6129
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LIVE WELL
Credential	:
Telephone Number	:	915-247-6129

Provider Enumeration Date	:	06/27/2023
Last Update Date	:	07/16/2023

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Directions to “LIVE WELL HOME CARE LLC ” Practice Location

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