Provider Demographics
NPI:1134687643
Name:HEALTHY LIVING HOME CARE LLC
Entity Type:Organization
Organization Name:HEALTHY LIVING HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-662-2153
Mailing Address - Street 1:15064 CARROLLTON BLVD STE 22
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-3582
Mailing Address - Country:US
Mailing Address - Phone:478-662-2153
Mailing Address - Fax:
Practice Address - Street 1:15064 CARROLLTON BLVD STE 22
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-3582
Practice Address - Country:US
Practice Address - Phone:478-662-2153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health