Provider Demographics
NPI:1477396117
Name:LIVING WELL HOME SERVICES LLC
Entity type:Organization
Organization Name:LIVING WELL HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CARE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DHA
Authorized Official - Phone:815-651-1766
Mailing Address - Street 1:7777 W LINCOLN HWY STE A1
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9490
Mailing Address - Country:US
Mailing Address - Phone:815-651-1766
Mailing Address - Fax:
Practice Address - Street 1:7777 W LINCOLN HWY STE A1
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-9490
Practice Address - Country:US
Practice Address - Phone:815-651-1766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child