Provider Demographics
NPI:1598308256
Name:LIVATHOME L.L.C.
Entity Type:Organization
Organization Name:LIVATHOME L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-925-3113
Mailing Address - Street 1:505 CORNHUSKER RD STE 105-195
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-7913
Mailing Address - Country:US
Mailing Address - Phone:402-925-3113
Mailing Address - Fax:402-925-3113
Practice Address - Street 1:2007 MORRIE DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4027
Practice Address - Country:US
Practice Address - Phone:402-925-3113
Practice Address - Fax:402-925-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health