Provider Demographics
NPI:1811527732
Name:LIVWELL HEALTH LLC
Entity type:Organization
Organization Name:LIVWELL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-788-2298
Mailing Address - Street 1:8541 E ANDERSON DR STE 104
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5430
Mailing Address - Country:US
Mailing Address - Phone:602-688-2248
Mailing Address - Fax:
Practice Address - Street 1:8541 E ANDERSON DR STE 104
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5430
Practice Address - Country:US
Practice Address - Phone:602-688-2248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-20
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion TherapyGroup - Multi-Specialty