Provider Demographics
NPI:1821630708
Name:ESSENTIAL LUXURIES, LLC
Entity Type:Organization
Organization Name:ESSENTIAL LUXURIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-978-8340
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-0062
Mailing Address - Country:US
Mailing Address - Phone:269-978-8340
Mailing Address - Fax:
Practice Address - Street 1:3243 BIRCH AVE
Practice Address - Street 2:
Practice Address - City:COLOMA
Practice Address - State:MI
Practice Address - Zip Code:49038-9117
Practice Address - Country:US
Practice Address - Phone:269-978-8340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-12
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies