Provider Demographics
NPI:1053879940
Name:LIVING THE GREEN
Entity type:Organization
Organization Name:LIVING THE GREEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VAVERCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:570-840-1952
Mailing Address - Street 1:106 WISTERIA LN
Mailing Address - Street 2:
Mailing Address - City:ARCHBALD
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1980
Mailing Address - Country:US
Mailing Address - Phone:570-840-1952
Mailing Address - Fax:
Practice Address - Street 1:106 WISTERIA LN
Practice Address - Street 2:
Practice Address - City:ARCHBALD
Practice Address - State:PA
Practice Address - Zip Code:18403-1980
Practice Address - Country:US
Practice Address - Phone:570-840-1952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUSTAIN HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-09
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty