Provider Demographics
NPI:1447938683
Name:LIVELY VIRTUAL CARE ORGANIZATION PC
Entity type:Organization
Organization Name:LIVELY VIRTUAL CARE ORGANIZATION PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:916-622-3609
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-0604
Mailing Address - Country:US
Mailing Address - Phone:916-622-3609
Mailing Address - Fax:916-333-3634
Practice Address - Street 1:108 BEN EZRA AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2702
Practice Address - Country:US
Practice Address - Phone:916-235-8617
Practice Address - Fax:916-846-9463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of Service
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies