Provider Demographics
NPI:1861554859
Name:LIVING WELL INC
Entity type:Organization
Organization Name:LIVING WELL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MS LCSW LMFT
Authorized Official - Phone:317-475-1389
Mailing Address - Street 1:6284 RUCKER RD
Mailing Address - Street 2:STE N
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4851
Mailing Address - Country:US
Mailing Address - Phone:317-475-1389
Mailing Address - Fax:317-594-1627
Practice Address - Street 1:6284 RUCKER RD
Practice Address - Street 2:STE N
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4851
Practice Address - Country:US
Practice Address - Phone:317-475-1389
Practice Address - Fax:317-594-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002279A1041C0700X
IN05000996A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN220970Medicare ID - Type UnspecifiedMEDICARE ID