Provider Demographics
NPI:1629799697
Name:LIFE ESSENTIALS HOME CARE LLC.
Entity Type:Organization
Organization Name:LIFE ESSENTIALS HOME CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:INDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-466-6434
Mailing Address - Street 1:1849 FAIRMOUNT AVE
Mailing Address - Street 2:P.O. BOX 121304 COVINGTON KENTUCKY 41012
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45214-1265
Mailing Address - Country:US
Mailing Address - Phone:859-466-6434
Mailing Address - Fax:
Practice Address - Street 1:1849 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45214-1265
Practice Address - Country:US
Practice Address - Phone:859-466-6434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care