NPIMap

Organization Active NPI

Living Well Healthcare, LLC

  • Rural Health Clinic/Center
  • Tompkinsville, KY
National Provider Identifier
1255609046
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LIVING WELL HEALTHCARE, LLC
Practice address
801 N Main St
Tompkinsville, KY 42167-1002
Phone
(270) 407-5052
NPI assigned
Dec 7, 2011
Last updated
May 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

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

Authorized official

Name
Deanna Nichols, NPNPI 1750464517
Title
Owner
Phone
(270) 407-5052

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

801 N Main St
Tompkinsville, KY 42167-1002

Mailing address

PO Box 669
Tompkinsville, KY 42167-0669
Phone (270) 407-5052

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120328000279 KY Part B Supplier - Clinic/Group Practice 9638339757 Receives reassigned benefits from 8 practitioners
Practice locations: Tompkinsville, KY
O20120706000637 KY Part A Provider - Rural Health Clinic 9638339757 Practice locations: Tompkinsville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255609046. Details of each certification follow.

Rural health clinic certification: CCN 188913

Legal name
LIVING WELL HEALTHCARE, LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 4, 2012
Last certification
Jun 25, 2019
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Nov 15, 2011 in KY
Enrollment address
801 N Main St
Tompkinsville, KY 42167-1002

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2033640Living Well Healthcare801 North Main St, Tompkinsville, KY 42167Certificate of waiverDec 6, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Deanna a Nichols Individual 5% Or Greater Direct Ownership Interest Nov 15, 2011 100%
Corporate OfficerPresident Nov 15, 2011
W-2 Managing EmployeePresident Nov 15, 2011

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 9

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": "1323216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1255609046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 669",
            "city": "TOMPKINSVILLE",
            "state": "KY",
            "postal_code": "421670669",
            "telephone_number": "270-407-5052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 N MAIN ST",
            "city": "TOMPKINSVILLE",
            "state": "KY",
            "postal_code": "421671002",
            "telephone_number": "270-407-5052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WELL HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-07",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "DEANNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-407-5052",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tompkinsville, KY

Sources for this page

Verify at the official NPI Registry.