Living Well Community, LLC

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

AL11733 Issued in FL

Legal business name

LIVING WELL COMMUNITY, LLC

Practice address

2222 John Moore Rd
Brandon, FL 33511-6333

Phone

(813) 661-7186

Fax

(813) 662-4324

NPI assigned

Dec 31, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Matthew Sherrod Wilson

Title

Co-Owner

Phone

(813) 494-0643

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1388448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388448000000",
    "number": "1689095192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 JOHN MOORE RD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335116333",
            "telephone_number": "813-661-7186",
            "fax_number": "813-662-4324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 JOHN MOORE RD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335116333",
            "telephone_number": "813-661-7186",
            "fax_number": "813-662-4324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WELL COMMUNITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-31",
        "last_updated": "2013-12-31",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "SHERROD",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "813-494-0643",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "FL",
            "license": "AL11733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Case Management Agency in Brandon, FL
• Providers in Brandon, FL by specialty
• Case Management Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2013; 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.