Provider Demographics
NPI:1366862146
Name:LIVINGWELL FOSTER CARE
Entity Type:Organization
Organization Name:LIVINGWELL FOSTER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:SHOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:IDAHOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-519-8195
Mailing Address - Street 1:53 OAK ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:53 OAK ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2744
Practice Address - Country:US
Practice Address - Phone:617-519-8195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency