Provider Demographics
NPI:1164912689
Name:LIVINGWELL N-HOME THERAPY LLC
Entity Type:Organization
Organization Name:LIVINGWELL N-HOME THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARMELO
Authorized Official - Middle Name:
Authorized Official - Last Name:TENUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-925-5000
Mailing Address - Street 1:600 52ND ST STE 240
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3423
Mailing Address - Country:US
Mailing Address - Phone:262-925-5004
Mailing Address - Fax:262-925-5001
Practice Address - Street 1:3921 30TH AVE STE B1
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1957
Practice Address - Country:US
Practice Address - Phone:262-909-2874
Practice Address - Fax:262-652-6305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty