Organization
LIVINGWELL HOME MEDICAL SUPPLIES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMELO D TENUTA PT (OWNER)
(262) 652-6288
Entity
Organization
Contact information
Practice address
3921 30TH AVE STE B, KENOSHA, WI 53144-1957
(262) 652-6288
(262) 652-6305
Mailing address
3921 30TH AVE STE B, KENOSHA, WI 53144-1957
(262) 652-6288
(262) 652-6305
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
456-1026819325-04
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6631630001
MEDICARE
WI
Enumeration date
12/23/2010
Last updated
02/28/2012
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