Provider Demographics
NPI:1831482421
Name:LIVE LONG WELL CARE ENTERPRISES LLC
Entity Type:Organization
Organization Name:LIVE LONG WELL CARE ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
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:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-246-1620
Mailing Address - Street 1:10706 SIKES PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8015
Mailing Address - Country:US
Mailing Address - Phone:704-246-1620
Mailing Address - Fax:704-246-1621
Practice Address - Street 1:10706 SIKES PL
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8015
Practice Address - Country:US
Practice Address - Phone:704-246-1620
Practice Address - Fax:704-246-1621
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVE LONG WELL CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993376251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health