Provider Demographics
NPI:1093069833
Name:LIFE'S ESSENTIAL SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:LIFE'S ESSENTIAL SUPPORT SERVICES, LLC
Other - Org Name:L.E.S.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WESTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-501-4943
Mailing Address - Street 1:18441 NW 2ND AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4517
Mailing Address - Country:US
Mailing Address - Phone:305-501-4943
Mailing Address - Fax:888-793-9311
Practice Address - Street 1:18441 NW 2ND AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4517
Practice Address - Country:US
Practice Address - Phone:305-501-4943
Practice Address - Fax:888-793-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management