MEDICARE: LUXE LEVEL 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1609410539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUXE LEVEL LLC

Provider Business Mailing Address
First Line	:	4000 HERITAGE VIEW TRL
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-8367
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 RAST ST
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-2579
Country	:	US
Telephone Number	:	919-264-2253
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RUSTOVIANT WRIGHTEN
Credential	:
Telephone Number	:	919-264-2253

Provider Enumeration Date	:	11/04/2019
Last Update Date	:	11/04/2019

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Directions to “LUXE LEVEL LLC ” Practice Location

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