Provider Demographics
NPI:1265972343
Name:LIVE WELL HOME HEALTH CARE
Entity type:Organization
Organization Name:LIVE WELL HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDELL-EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-332-4980
Mailing Address - Street 1:3224 JARED COURT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3224 JARED CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-5018
Practice Address - Country:US
Practice Address - Phone:614-332-4980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201703102098251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health