Provider Demographics
NPI:1508272360
Name:HEALTHY LIVING AT HOME - EL CENTRO, LLC.
Entity Type:Organization
Organization Name:HEALTHY LIVING AT HOME - EL CENTRO, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-545-0330
Mailing Address - Street 1:502 W ATEN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-9423
Mailing Address - Country:US
Mailing Address - Phone:760-545-0330
Mailing Address - Fax:
Practice Address - Street 1:502 W ATEN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-9423
Practice Address - Country:US
Practice Address - Phone:760-545-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health