Provider Demographics
NPI:1013371251
Name:LIVE LONG WELL CARE, LLC
Entity Type:Organization
Organization Name:LIVE LONG WELL CARE, LLC
Other - Org Name:LIVE LONG WELL CARE OF MARSH'S EDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:O
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-246-1620
Mailing Address - Street 1:3530 TORINGDON WAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277
Mailing Address - Country:US
Mailing Address - Phone:704-246-1620
Mailing Address - Fax:704-246-1621
Practice Address - Street 1:136 MARSHS EDGE LN
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-8898
Practice Address - Country:US
Practice Address - Phone:912-291-2006
Practice Address - Fax:912-291-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health