Provider Demographics
NPI:1558683094
Name:LUXURIOUS ESSENTIALS LLC
Entity Type:Organization
Organization Name:LUXURIOUS ESSENTIALS LLC
Other - Org Name:LUXURIOUS ESSENTIALS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-655-3860
Mailing Address - Street 1:19405 HASSE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-2195
Mailing Address - Country:US
Mailing Address - Phone:313-655-3860
Mailing Address - Fax:
Practice Address - Street 1:20755 GREENFIELD RD
Practice Address - Street 2:SUITE 610
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5403
Practice Address - Country:US
Practice Address - Phone:313-655-3860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty