Provider Demographics
NPI:1780604009
Name:LIVING & WELLNESS CENTERS PS
Entity type:Organization
Organization Name:LIVING & WELLNESS CENTERS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAVSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-473-2663
Mailing Address - Street 1:3716 PACIFIC AVE
Mailing Address - Street 2:#E
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418
Mailing Address - Country:US
Mailing Address - Phone:253-473-2663
Mailing Address - Fax:253-473-0545
Practice Address - Street 1:3716 PACIFIC AVE
Practice Address - Street 2:#E
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418
Practice Address - Country:US
Practice Address - Phone:253-473-2663
Practice Address - Fax:253-473-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA878208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6106005600OtherOWCP
WA143803OtherL & I
D33878Medicare UPIN
WAG8854925Medicare ID - Type Unspecified