Provider Demographics
NPI:1558832287
Name:LIVING MY BEST LIFE CDS, LLC
Entity Type:Organization
Organization Name:LIVING MY BEST LIFE CDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KSI
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-695-4244
Mailing Address - Street 1:3004 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-1513
Mailing Address - Country:US
Mailing Address - Phone:314-695-4244
Mailing Address - Fax:
Practice Address - Street 1:3004 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1513
Practice Address - Country:US
Practice Address - Phone:314-695-4244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health