Provider Demographics
NPI:1700566163
Name:BUTTERFLY LMD ENTERPRISE, INC
Entity Type:Organization
Organization Name:BUTTERFLY LMD ENTERPRISE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEIDRE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-691-3189
Mailing Address - Street 1:5223 VILLE ANITA CT
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1608
Mailing Address - Country:US
Mailing Address - Phone:314-691-3189
Mailing Address - Fax:
Practice Address - Street 1:5223 VILLE ANITA CT
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1608
Practice Address - Country:US
Practice Address - Phone:314-691-3189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility