Provider Demographics
NPI:1699820845
Name:LIVE CENTER INC.
Entity Type:Organization
Organization Name:LIVE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-374-3742
Mailing Address - Street 1:407 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:LEMMON
Mailing Address - State:SD
Mailing Address - Zip Code:57638-1405
Mailing Address - Country:US
Mailing Address - Phone:605-374-3742
Mailing Address - Fax:605-374-3238
Practice Address - Street 1:407 2ND AVE W
Practice Address - Street 2:
Practice Address - City:LEMMON
Practice Address - State:SD
Practice Address - Zip Code:57638-1405
Practice Address - Country:US
Practice Address - Phone:605-374-3742
Practice Address - Fax:605-374-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD9515060343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9515060Medicaid