Healthcare Provider Details

I. General information

NPI: 1023779725
Provider Name (Legal Business Name): ESSENTIAL LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 11/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 LANSING DR
SAINT ANN MO
63074-3428
US

IV. Provider business mailing address

3315 LANSING DR
SAINT ANN MO
63074-3428
US

V. Phone/Fax

Practice location:
  • Phone: 314-514-5166
  • Fax: 314-932-0933
Mailing address:
  • Phone: 314-514-5166
  • Fax: 314-932-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHARDENEY TAJON MANERS
Title or Position: CO-CEO
Credential:
Phone: 314-374-3438