Provider Demographics
NPI: | 1851897870 |
---|---|
Name: | LIVE BETTER LLC |
Entity Type: | Organization |
Organization Name: | LIVE BETTER LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KHALID |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SHARIF |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 612-205-0723 |
Mailing Address - Street 1: | 2121 NICOLLET AVE SUITE 206 |
Mailing Address - Street 2: | |
Mailing Address - City: | MINNEAPOLIS |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55404 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 612-205-0723 |
Mailing Address - Fax: | 612-354-3594 |
Practice Address - Street 1: | 2277 HIGHWAY 36 W STE 306 |
Practice Address - Street 2: | |
Practice Address - City: | ROSEVILLE |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55113-3830 |
Practice Address - Country: | US |
Practice Address - Phone: | 612-205-0723 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-03-30 |
Last Update Date: | 2018-10-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 251S00000X | |
MN | 1080256 | 253Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 253Z00000X | Agencies | In Home Supportive Care | |
No | 251S00000X | Agencies | Community/Behavioral Health |