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Organization
LIVING WELL PERSONAL CARE HOME LLC
Active
Organization
LIVING WELL PERSONAL CARE HOME LLC
Active
Other names
Living Well Personal Care Home LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGENETTE YVONNE AGAMA (OWNER/ADMINISTRATOR)
(678) 829-3499
Entity
Organization
Contact information
Practice address
10903 WHEELER TRCE, HAMPTON, GA 30228-6461
(678) 829-3499
(678) 829-3499
Mailing address
10903 WHEELER TRCE, HAMPTON, GA 30228-6461
(678) 829-3499
(678) 829-3499
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
03/06/2023
Last updated
03/09/2023
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