Provider Demographics
NPI:1033471966
Name:LIVE WELL ALF CORP.
Entity Type:Organization
Organization Name:LIVE WELL ALF CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:305-979-8085
Mailing Address - Street 1:8886 NW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1986
Mailing Address - Country:US
Mailing Address - Phone:786-360-4455
Mailing Address - Fax:866-243-4467
Practice Address - Street 1:8886 NW 119TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-1986
Practice Address - Country:US
Practice Address - Phone:786-360-4455
Practice Address - Fax:866-243-4467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12102310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility