Provider Demographics
NPI:1003535378
Name:LIVEWELL CLINIC LLC
Entity type:Organization
Organization Name:LIVEWELL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCAS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:503-805-1186
Mailing Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY STE 300A-4
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3019
Mailing Address - Country:US
Mailing Address - Phone:503-887-0311
Mailing Address - Fax:503-530-8581
Practice Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY STE 300A-4
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3019
Practice Address - Country:US
Practice Address - Phone:503-887-0311
Practice Address - Fax:503-530-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care