Provider Demographics
NPI:1912201534
Name:LIVINGWELL HOME MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:LIVINGWELL HOME MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMELO
Authorized Official - Middle Name:D
Authorized Official - Last Name:TENUTA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:262-652-6288
Mailing Address - Street 1:3921 30TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1957
Mailing Address - Country:US
Mailing Address - Phone:262-652-6288
Mailing Address - Fax:262-652-6305
Practice Address - Street 1:3921 30TH AVE STE B
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1957
Practice Address - Country:US
Practice Address - Phone:262-652-6288
Practice Address - Fax:262-652-6305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI456-1026819325-04332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6631630001OtherMEDICARE