Provider Demographics
NPI:1609363175
Name:LIV WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:LIV WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ROBILIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-403-6446
Mailing Address - Street 1:4949 S CONGRESS AVE STE E
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4731
Mailing Address - Country:US
Mailing Address - Phone:888-403-6446
Mailing Address - Fax:
Practice Address - Street 1:4949 S CONGRESS AVE STE E
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-4731
Practice Address - Country:US
Practice Address - Phone:888-403-6446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP2701X
FL1018009261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1018009OtherDEPARTMENT OF CHILDREN AND FAMILIES