Provider Demographics
NPI:1386950939
Name:LIVITUP, INC
Entity type:Organization
Organization Name:LIVITUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/BOARD MEMNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:NOLEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:EMT-IV, CAC
Authorized Official - Phone:901-333-1031
Mailing Address - Street 1:PO BOX 381167
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183
Mailing Address - Country:US
Mailing Address - Phone:901-761-4277
Mailing Address - Fax:901-761-7876
Practice Address - Street 1:3239 PLAYERS CLUB PARKWAY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125
Practice Address - Country:US
Practice Address - Phone:901-761-4277
Practice Address - Fax:901-761-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000005751253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care