Provider Demographics
NPI:1477834919
Name:LIVEWELL BUILDERS
Entity type:Organization
Organization Name:LIVEWELL BUILDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:GLOETZNER
Authorized Official - Suffix:
Authorized Official - Credentials:GB-98
Authorized Official - Phone:505-281-9109
Mailing Address - Street 1:30 SHADE TREE LN
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-7637
Mailing Address - Country:US
Mailing Address - Phone:505-281-9109
Mailing Address - Fax:
Practice Address - Street 1:30 SHADE TREE LN
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-7637
Practice Address - Country:US
Practice Address - Phone:505-281-9109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty