Provider Demographics
NPI:1821260779
Name:LIVE LONG WELL CARE, LLC
Entity Type:Organization
Organization Name:LIVE LONG WELL CARE, LLC
Other - Org Name:LIVE LONG WELL CARE OF NASSAU COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:O
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-246-1616
Mailing Address - Street 1:10706 SIKES PL STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8015
Mailing Address - Country:US
Mailing Address - Phone:704-246-1616
Mailing Address - Fax:
Practice Address - Street 1:48 OSPREY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:AMELIA ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32034-4955
Practice Address - Country:US
Practice Address - Phone:704-246-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health