Organization
LIFE WELL LIVED SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCHNYEDER DESTINE (EXECUTIVE CHAIRMAN)
(770) 529-3754
Entity
Organization
Contact information
Practice address
6941 HIGHWAY 92, SUITE 120, WOODSTOCK, GA 30189-3465
(770) 529-3754
(770) 693-8014
Mailing address
6941 HIGHWAY 92, SUITE 120, WOODSTOCK, GA 30189-3465
(770) 529-3754
(770) 693-8014
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363207706B
—
GA
Enumeration date
10/24/2013
Last updated
10/24/2013
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