Provider Demographics
NPI:1215583372
Name:LIVELINESS SERVICES INC
Entity Type:Organization
Organization Name:LIVELINESS SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONSUELO
Authorized Official - Middle Name:R
Authorized Official - Last Name:ESCALONA FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-330-5902
Mailing Address - Street 1:5190 NW 167TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6338
Mailing Address - Country:US
Mailing Address - Phone:929-330-5902
Mailing Address - Fax:
Practice Address - Street 1:5190 NW 167TH ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6338
Practice Address - Country:US
Practice Address - Phone:929-330-5902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management