Provider Demographics
NPI:1629466537
Name:LLIVE-WELL ICF INC
Entity Type:Organization
Organization Name:LLIVE-WELL ICF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, DRHEDC
Authorized Official - Phone:323-445-1522
Mailing Address - Street 1:13888 SHABLOW AVE
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1915
Mailing Address - Country:US
Mailing Address - Phone:323-445-1522
Mailing Address - Fax:
Practice Address - Street 1:13888 SHABLOW AVE
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1915
Practice Address - Country:US
Practice Address - Phone:323-445-1522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities