Healthcare Provider Details

I. General information

NPI: 1467742122
Provider Name (Legal Business Name): LIVING LIFE LONG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 UNION BLVD SUITE 300
SAINT LOUIS MO
63108-4400
US

IV. Provider business mailing address

303 UNION BLVD SUITE 300
SAINT LOUIS MO
63108-4400
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-4400
  • Fax:
Mailing address:
  • Phone: 314-361-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON L BEATTY
Title or Position: OWNER/MANAGING PARTNER
Credential: MPH
Phone: 314-361-4400