NPIMap

Organization Active NPI

Living Well 4 Life

  • Clinical Social Worker
  • Jackson, NJ
National Provider Identifier
1174140271
Registry record updated Jul 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
LIVING WELL 4 LIFE
Practice address
405 Daffodil Dr
Jackson, NJ 08527-4125
Phone
(732) 966-5809
NPI assigned
Jul 6, 2020
Last updated
Jul 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2020

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

Authorized official

Name
Rekishia L McMillan, MSWNPI 1225504103
Title
Owner
Phone
(732) 966-5809

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

405 Daffodil Dr
Jackson, NJ 08527-4125

Mailing address

405 Daffodil Dr
Jackson, NJ 08527-4125
Phone (732) 966-5809

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1593993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593993600000",
    "number": "1174140271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 DAFFODIL DR",
            "city": "JACKSON",
            "state": "NJ",
            "postal_code": "085274125",
            "telephone_number": "732-966-5809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 DAFFODIL DR",
            "city": "JACKSON",
            "state": "NJ",
            "postal_code": "085274125",
            "telephone_number": "732-966-5809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WELL 4 LIFE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-06",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A",
        "authorized_official_last_name": "MCMILLAN",
        "authorized_official_first_name": "REKISHIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-966-5809",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2020; 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.