Organization
LIVING WELL COMMUNITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW SHERROD WILSON (CO-OWNER)
(813) 494-0643
Entity
Organization
Contact information
Practice address
2222 JOHN MOORE RD, BRANDON, FL 33511-6333
(813) 661-7186
(813) 662-4324
Mailing address
2222 JOHN MOORE RD, BRANDON, FL 33511-6333
(813) 661-7186
(813) 662-4324
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
AL11733
FL
Other
Enumeration date
12/31/2013
Last updated
12/31/2013
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