| Live Purposely Llc | |
|
510 Vonderburg Dr Ste 103 Brandon FL 33511-6047 | |
| (813) 937-9310 | |
| (813) 937-9317 |
| Full Name | Live Purposely Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 510 Vonderburg Dr Ste 103, Brandon, Florida |
| Authorized Official Name and Position | Joanne C Bonami (OWNER) |
| Authorized Official Contact | 8139379310 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Purposely Llc 13194 Us Highway 301 S Ste 375 Riverview FL 33578-7410 Ph: (813) 937-9310 | Live Purposely Llc 510 Vonderburg Dr Ste 103 Brandon FL 33511-6047 Ph: (813) 937-9310 |
| NPI Number | 1164148029 |
|---|---|
| Provider Enumeration Date | 10/12/2022 |
| Last Update Date | 10/12/2022 |
| Certification Date | 10/12/2022 |
| Medicare PECOS PAC ID | 4082081708 |
|---|---|
| Medicare Enrollment ID | O20221108003480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164148029 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Joanne C Bonami |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205161221 PECOS PAC ID: 3678987484 Enrollment ID: I20210205000665 |
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