Provider Demographics
NPI:1205173952
Name:LIVING WELL IN COMPANY
Entity type:Organization
Organization Name:LIVING WELL IN COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCSW
Authorized Official - Phone:317-475-1389
Mailing Address - Street 1:6284 RUCKER RD
Mailing Address - Street 2:SUITE N
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4865
Mailing Address - Country:US
Mailing Address - Phone:317-475-1389
Mailing Address - Fax:317-475-9089
Practice Address - Street 1:6284 RUCKER RD
Practice Address - Street 2:SUITE N
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4865
Practice Address - Country:US
Practice Address - Phone:317-475-1389
Practice Address - Fax:317-475-9089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05000996A225100000X
IN34002279A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty