Provider Demographics
NPI:1841920105
Name:LIVINGWELL COMPREHENSIVE MEDICAL & PSYCHIATRIC CARE
Entity type:Organization
Organization Name:LIVINGWELL COMPREHENSIVE MEDICAL & PSYCHIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-LESLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGAUD
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:954-807-3160
Mailing Address - Street 1:PO BOX 970788
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33497-0788
Mailing Address - Country:US
Mailing Address - Phone:954-807-3160
Mailing Address - Fax:
Practice Address - Street 1:4651 N STATE ROAD 7 STE 9
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4378
Practice Address - Country:US
Practice Address - Phone:954-807-3160
Practice Address - Fax:561-370-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117534300Medicaid