Provider Demographics
NPI:1003543968
Name:LIVING LIFE SKILLED NURSING LLC
Entity Type:Organization
Organization Name:LIVING LIFE SKILLED NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THEENG
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-481-7203
Mailing Address - Street 1:787 GREY ROCK RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-4983
Mailing Address - Country:US
Mailing Address - Phone:678-481-7203
Mailing Address - Fax:770-807-0504
Practice Address - Street 1:787 GREY ROCK RD # 10
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-4983
Practice Address - Country:US
Practice Address - Phone:678-481-7198
Practice Address - Fax:770-807-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health