Living Well Personal Care Home LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

LIVING WELL PERSONAL CARE HOME LLC

Practice address

10903 Wheeler Trce
Hampton, GA 30228-6461

Phone

(678) 829-3499

Fax

(678) 829-3499

NPI assigned

Mar 6, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Angenette Yvonne Agama

Title

Owner/Administrator

Phone

(678) 829-3499

Specialties & licenses 1

Addresses

Other names 1

• Living Well Personal Care Home LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678320000000",
    "number": "1134829567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10903 WHEELER TRCE",
            "city": "HAMPTON",
            "state": "GA",
            "postal_code": "302286461",
            "telephone_number": "678-829-3499",
            "fax_number": "678-829-3499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10903 WHEELER TRCE",
            "city": "HAMPTON",
            "state": "GA",
            "postal_code": "302286461",
            "telephone_number": "678-829-3499",
            "fax_number": "678-829-3499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WELL PERSONAL CARE HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-06",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "AGAMA",
        "authorized_official_first_name": "ANGENETTE",
        "authorized_official_middle_name": "YVONNE",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "678-829-3499",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Living Well Personal Care Home LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Hampton, GA
• Providers in Hampton, GA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.