Provider Demographics
NPI:1639854318
Name:LIVING LIFE LONG RESIDENTIAL CARE
Entity Type:Organization
Organization Name:LIVING LIFE LONG RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRONE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-497-5284
Mailing Address - Street 1:303 UNION BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-4402
Mailing Address - Country:US
Mailing Address - Phone:314-495-5498
Mailing Address - Fax:866-883-0221
Practice Address - Street 1:5076 WATERMAN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1102
Practice Address - Country:US
Practice Address - Phone:314-495-5498
Practice Address - Fax:866-883-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility