| Living Well 4 Life | |
|
405 Daffodil Dr Jackson NJ 08527-4125 | |
| (732) 966-5809 | |
| Not Available |
| Full Name | Living Well 4 Life |
|---|---|
| Speciality | Social Worker |
| Location | 405 Daffodil Dr, Jackson, New Jersey |
| Authorized Official Name and Position | Rekishia L Mcmillan (OWNER) |
| Authorized Official Contact | 7329665809 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Well 4 Life 405 Daffodil Dr Jackson NJ 08527-4125 Ph: (732) 966-5809 | Living Well 4 Life 405 Daffodil Dr Jackson NJ 08527-4125 Ph: (732) 966-5809 |
| NPI Number | 1174140271 |
|---|---|
| Provider Enumeration Date | 07/06/2020 |
| Last Update Date | 07/06/2020 |
| Certification Date | 07/06/2020 |
| Medicare PECOS PAC ID | 7517383789 |
|---|---|
| Medicare Enrollment ID | O20200818003579 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174140271 | NPI | - | NPPES |
| 14356384 | Other | NJ | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Rekishia Lashon Mcmillan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225504103 PECOS PAC ID: 8426474693 Enrollment ID: I20200819000069 |
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