Organization
LIVING WELL AT HOME
Active
Other names
LWAH
Organization subpart
No
Provider details
NPI number
Authorized official
SHANELL LOVETTE WOODLEY RN (RN CLINICAL COORDINATOR)
(713) 665-9952
Entity
Organization
Contact information
Practice address
103 RIVERSIDE AVE, FLANDERS, NY 11901-3850
(631) 591-0298
(631) 740-9233
Mailing address
PO BOX 2177, RIVERHEAD, NY 11901-0177
(631) 591-0298
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
—
NY
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902324502
—
NY
Enumeration date
11/28/2017
Last updated
11/28/2017
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