Provider Demographics
NPI:1609468792
Name:LIVELY STAFFING&HOMECAREAGENCY
Entity Type:Organization
Organization Name:LIVELY STAFFING&HOMECAREAGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FOLAKE
Authorized Official - Middle Name:OLAWUNMI
Authorized Official - Last Name:OWODUNNI
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED VOCATIONAL
Authorized Official - Phone:424-229-4150
Mailing Address - Street 1:21171 S WESTERN AVE STE 2710
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1728
Mailing Address - Country:US
Mailing Address - Phone:424-229-4150
Mailing Address - Fax:
Practice Address - Street 1:21171 S WESTERN AVE STE 2710
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1728
Practice Address - Country:US
Practice Address - Phone:424-229-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child