Provider Demographics
NPI:1225450760
Name:LIVING WELL HOME SERVICES LLC
Entity Type:Organization
Organization Name:LIVING WELL HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:DEANNA
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:313-402-4570
Mailing Address - Street 1:16500 JOY RD UNIT 28138
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-0604
Mailing Address - Country:US
Mailing Address - Phone:313-402-4570
Mailing Address - Fax:313-731-0389
Practice Address - Street 1:25900 GREENFIELD RD STE 503
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1893
Practice Address - Country:US
Practice Address - Phone:313-402-4570
Practice Address - Fax:313-731-0389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI6801091301251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty