Provider Demographics
NPI:1649760075
Name:LIVEWELL FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:LIVEWELL FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ARKHURST
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-613-0529
Mailing Address - Street 1:3611 BRANCH AVE STE 4043611
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1242
Mailing Address - Country:US
Mailing Address - Phone:240-719-2587
Mailing Address - Fax:240-830-2320
Practice Address - Street 1:3611 BRANCH AVE STE 404
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748
Practice Address - Country:US
Practice Address - Phone:240-719-2587
Practice Address - Fax:240-830-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190895261QP2300X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty