Healthcare Provider Details

I. General information

NPI: 1073375879
Provider Name (Legal Business Name): EASY LIVING ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 W 82ND PL
MERRILLVILLE IN
46410-6140
US

IV. Provider business mailing address

2017 W 82ND PL
MERRILLVILLE IN
46410-6140
US

V. Phone/Fax

Practice location:
  • Phone: 708-600-3697
  • Fax:
Mailing address:
  • Phone: 708-600-3697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: KENDALL KENNEDY
Title or Position: FOUNDER
Credential:
Phone: 708-600-3697