Provider Demographics
NPI:1467742122
Name:LIVING LIFE LONG, LLC
Entity Type:Organization
Organization Name:LIVING LIFE LONG, LLC
Other - Org Name:HOMEWELL SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:314-361-4400
Mailing Address - Street 1:303 UNION BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-4400
Mailing Address - Country:US
Mailing Address - Phone:314-361-4400
Mailing Address - Fax:
Practice Address - Street 1:303 UNION BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-4400
Practice Address - Country:US
Practice Address - Phone:314-361-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251E00000X, 251J00000X, 253Z00000X
MO343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No343800000XTransportation ServicesSecured Medical Transport (VAN)