Provider Demographics
NPI:1467924506
Name:LIVEWELL HOME
Entity Type:Organization
Organization Name:LIVEWELL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAIWO
Authorized Official - Middle Name:
Authorized Official - Last Name:ELEMUREN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:323-445-3391
Mailing Address - Street 1:6934 ROSALINA LANDING LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2322
Mailing Address - Country:US
Mailing Address - Phone:323-445-3391
Mailing Address - Fax:
Practice Address - Street 1:6934 ROSALINA LANDING LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2322
Practice Address - Country:US
Practice Address - Phone:323-445-3391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health