Provider Demographics
NPI:1649637885
Name:LIVING ESSENTIALS IN HOME SERVICES LLC
Entity type:Organization
Organization Name:LIVING ESSENTIALS IN HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENEISHIA
Authorized Official - Middle Name:CHAVON
Authorized Official - Last Name:ELIJAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-369-0475
Mailing Address - Street 1:1515 N WARSON RD
Mailing Address - Street 2:STE 116
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1111
Mailing Address - Country:US
Mailing Address - Phone:314-369-0475
Mailing Address - Fax:314-260-6781
Practice Address - Street 1:1515 N WARSON RD
Practice Address - Street 2:STE 116
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1111
Practice Address - Country:US
Practice Address - Phone:314-369-0475
Practice Address - Fax:314-260-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care