Provider Demographics
NPI:1396271532
Name:LIVEWELL ALLIANCE, INC.
Entity type:Organization
Organization Name:LIVEWELL ALLIANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF REV & REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ANYA
Authorized Official - Middle Name:MARISSE
Authorized Official - Last Name:BOUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-628-3059
Mailing Address - Street 1:1261 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1750
Mailing Address - Country:US
Mailing Address - Phone:860-628-9000
Mailing Address - Fax:
Practice Address - Street 1:1261 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1750
Practice Address - Country:US
Practice Address - Phone:860-628-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-09
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0096471041C0700X
CT003405225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty