Provider Demographics
NPI:1134512833
Name:LIVING WELL HEALTH CARE, LLC
Entity Type:Organization
Organization Name:LIVING WELL HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:303-481-3451
Mailing Address - Street 1:860 E 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80229-7102
Mailing Address - Country:US
Mailing Address - Phone:303-481-3451
Mailing Address - Fax:720-889-9496
Practice Address - Street 1:90 MADISON ST
Practice Address - Street 2:SUITE 305
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5418
Practice Address - Country:US
Practice Address - Phone:303-481-3451
Practice Address - Fax:720-889-9496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP990096363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23838736Medicaid