Healthcare Provider Details

I. General information

NPI: 1992530307
Provider Name (Legal Business Name): ESSENTIAL LUXURY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 OLD TOWN MALL
BALTIMORE MD
21202-4190
US

IV. Provider business mailing address

544 OLD TOWN MALL
BALTIMORE MD
21202-4190
US

V. Phone/Fax

Practice location:
  • Phone: 443-793-8485
  • Fax:
Mailing address:
  • Phone: 443-793-8485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHANTIA BEAN
Title or Position: OWNER
Credential:
Phone: 443-793-8485