Provider Demographics
NPI:1508202110
Name:LIVING HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:LIVING HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HELMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-755-2582
Mailing Address - Street 1:3434 HONDO PASS DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-1015
Mailing Address - Country:US
Mailing Address - Phone:915-755-2582
Mailing Address - Fax:
Practice Address - Street 1:3434 HONDO PASS DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-1015
Practice Address - Country:US
Practice Address - Phone:915-755-2582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX308435Medicare PIN