Healthcare Provider Details

I. General information

NPI: 1417764283
Provider Name (Legal Business Name): L&L COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11875 OLD HALLS FERRY RD
BLACK JACK MO
63033-6825
US

IV. Provider business mailing address

4571 LACLEDE AVE PMB# 145
ST LOUIS MO
63108
US

V. Phone/Fax

Practice location:
  • Phone: 832-696-9868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LESLIE LENOIR
Title or Position: CO-OWNER
Credential:
Phone: 832-696-9868