Provider Demographics
NPI:1073220380
Name:LILLY'S SENIOR SERVICES LLC
Entity Type:Organization
Organization Name:LILLY'S SENIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRISTER-LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:L1MA
Authorized Official - Phone:314-620-7905
Mailing Address - Street 1:3470 HAMPTON AVE STE 101C
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-1936
Mailing Address - Country:US
Mailing Address - Phone:316-659-8311
Mailing Address - Fax:
Practice Address - Street 1:3470 HAMPTON AVE STE 101C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-1936
Practice Address - Country:US
Practice Address - Phone:316-659-8311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health