Provider Demographics
NPI:1982764932
Name:LIVING WELL HOME CARE, LLC
Entity Type:Organization
Organization Name:LIVING WELL HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR - MEDICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-629-9994
Mailing Address - Street 1:1351 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MO
Mailing Address - Zip Code:63077-2438
Mailing Address - Country:US
Mailing Address - Phone:636-629-9994
Mailing Address - Fax:636-629-9945
Practice Address - Street 1:1351 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MO
Practice Address - Zip Code:63077-2438
Practice Address - Country:US
Practice Address - Phone:636-629-9994
Practice Address - Fax:636-629-9945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0007754251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health