Provider Demographics
NPI:1548922792
Name:LIVE EMERGE AND PERSEVERE LLC
Entity type:Organization
Organization Name:LIVE EMERGE AND PERSEVERE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LASHANDA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:850-284-3245
Mailing Address - Street 1:2169 FOREST RIDGE RD SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-4973
Mailing Address - Country:US
Mailing Address - Phone:678-638-0460
Mailing Address - Fax:
Practice Address - Street 1:2169 FOREST RIDGE RD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-4973
Practice Address - Country:US
Practice Address - Phone:678-638-0460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHCP011213OtherPRIVATE HOMECARE PROVIDER PERMIT