Provider Demographics
NPI:1336544923
Name:LIVING HEALTHY SOLUTIONS, LLC C/O SEVA
Entity type:Organization
Organization Name:LIVING HEALTHY SOLUTIONS, LLC C/O SEVA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, ACCOUNT MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURGEOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-919-2088
Mailing Address - Street 1:2870 PEACHTREE RD NW
Mailing Address - Street 2:#315
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:970 MANSELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1506
Practice Address - Country:US
Practice Address - Phone:404-919-2088
Practice Address - Fax:708-294-1284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-26
Last Update Date:2014-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1744P3200X335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier