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NPI Code Detail

MEDICARE: LIVE LONG WELL CARE ENTERPRISES LLC

MEDICARE: LIVE LONG WELL CARE ENTERPRISES 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
1251E00000XHome Health Agency299993376FL

General Provider Information

NPI Number : 1831482421
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIVE LONG WELL CARE ENTERPRISES LLC
Provider Business Mailing Address
First Line : 10706 SIKES PL
Second Line : SUITE 200
City : CHARLOTTE
State : NC
Zip : 28277-8015
Country : US
Telephone Number : 704-246-1620
Fax Number : 704-246-1621
Provider Business Practice Location Address
First Line : 10706 SIKES PL
Second Line : SUITE 200
City : CHARLOTTE
State : NC
Zip : 28277-8015
Country : US
Telephone Number : 704-246-1620
Fax Number : 704-246-1621
Authorized Official
Title or Position : MANAGER
Name : DONALD O THOMPSON JR.
Credential :
Telephone Number : 704-246-1620
Provider Enumeration Date : 05/16/2011
Last Update Date : 05/16/2011

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Directions to “LIVE LONG WELL CARE ENTERPRISES LLC ” Practice Location

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