Provider Demographics
NPI:1417696626
Name:LASMO DYNAMIC CONCEPT LLC
Entity Type:Organization
Organization Name:LASMO DYNAMIC CONCEPT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:IKECHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-552-2430
Mailing Address - Street 1:8400 W VIRGINIA AVE APT 1023
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-8347
Mailing Address - Country:US
Mailing Address - Phone:480-452-2430
Mailing Address - Fax:
Practice Address - Street 1:8400 W VIRGINIA AVE APT 1023
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-8347
Practice Address - Country:US
Practice Address - Phone:480-452-2430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty