Provider Demographics
NPI:1598386526
Name:LIVEWELL HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:LIVEWELL HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORDELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EKWUEME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-204-6262
Mailing Address - Street 1:11512 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 201D
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3440
Mailing Address - Country:US
Mailing Address - Phone:414-375-7051
Mailing Address - Fax:262-643-4150
Practice Address - Street 1:11512 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 201D
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3440
Practice Address - Country:US
Practice Address - Phone:414-375-7051
Practice Address - Fax:262-643-4150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health