Provider Demographics
NPI:1700338795
Name:LIVING WELL TEXAS HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:LIVING WELL TEXAS HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN SICKLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-970-6155
Mailing Address - Street 1:1644 W HENDERSON ST
Mailing Address - Street 2:#200
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4026
Mailing Address - Country:US
Mailing Address - Phone:682-970-6155
Mailing Address - Fax:682-970-6255
Practice Address - Street 1:1644 W HENDERSON ST
Practice Address - Street 2:#200
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4026
Practice Address - Country:US
Practice Address - Phone:682-970-6155
Practice Address - Fax:682-970-6255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health