Provider Demographics
NPI:1114055902
Name:LIVE WELL HOME CARE
Entity Type:Organization
Organization Name:LIVE WELL HOME CARE
Other - Org Name:CURA HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-289-5650
Mailing Address - Street 1:520 W BROADWAY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3882
Mailing Address - Country:US
Mailing Address - Phone:918-710-5013
Mailing Address - Fax:918-994-6289
Practice Address - Street 1:520 W BROADWAY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3882
Practice Address - Country:US
Practice Address - Phone:918-710-5013
Practice Address - Fax:918-994-6289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7029251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100261180AMedicaid
OK377205Medicare ID - Type Unspecified