Provider Demographics
NPI:1134782154
Name:LIVING WELL MANAGEMENT, INC
Entity type:Organization
Organization Name:LIVING WELL MANAGEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:ALEJO
Authorized Official - Last Name:QUINTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-342-8736
Mailing Address - Street 1:8725 NW 18TH TER STE 102
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2629
Mailing Address - Country:US
Mailing Address - Phone:305-342-8736
Mailing Address - Fax:
Practice Address - Street 1:3601 W COMMERCIAL BLVD STE 21
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3320
Practice Address - Country:US
Practice Address - Phone:954-909-0407
Practice Address - Fax:954-909-0408
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVING WELL MANAGEMENT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-16
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34545OtherAHCA