Provider Demographics
NPI:1740997329
Name:LIFE ESSENTIAL LLC
Entity type:Organization
Organization Name:LIFE ESSENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLLOMON
Authorized Official - Suffix:JR
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:954-907-0920
Mailing Address - Street 1:6574 N STATE ROAD 7 # 344
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3625
Mailing Address - Country:US
Mailing Address - Phone:754-422-3608
Mailing Address - Fax:
Practice Address - Street 1:5851 HOLMBERG RD APT 3122
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-4516
Practice Address - Country:US
Practice Address - Phone:754-422-3608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No174200000XOther Service ProvidersMeals
No332U00000XSuppliersHome Delivered Meals
No347C00000XTransportation ServicesPrivate Vehicle