1740520683 NPI number — LIVEWELL OPERATIONS I INC

Table of content: (NPI 1740520683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740520683 NPI number — LIVEWELL OPERATIONS I INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIVEWELL OPERATIONS I INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LIVEWELL AT CORAL PLAZA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740520683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5850 MARGATE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARGATE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33063-3621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-970-0053
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5850 MARGATE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARGATE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33063-3621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-970-0053
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHMARYOU
Authorized Official First Name:
YANIR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-970-0053

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL7861 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)