Provider Demographics
NPI:1902355431
Name:LIVINGWELL DAY CARE CENTER LLC
Entity Type:Organization
Organization Name:LIVINGWELL DAY CARE CENTER LLC
Other - Org Name:LIVINGWELL SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIEMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-395-7768
Mailing Address - Street 1:13781 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4320
Mailing Address - Country:US
Mailing Address - Phone:929-362-2477
Mailing Address - Fax:929-362-2451
Practice Address - Street 1:13781 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4320
Practice Address - Country:US
Practice Address - Phone:929-362-2477
Practice Address - Fax:929-362-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home