Healthcare Provider Details

I. General information

NPI: 1629799697
Provider Name (Legal Business Name): LIFE ESSENTIALS HOME CARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 FAIRMOUNT AVE
CINCINNATI OH
45214-1265
US

IV. Provider business mailing address

1849 FAIRMOUNT AVE P.O. BOX 121304 COVINGTON KENTUCKY 41012
CINCINNATI OH
45214-1265
US

V. Phone/Fax

Practice location:
  • Phone: 859-466-6434
  • Fax:
Mailing address:
  • Phone: 859-466-6434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. INDIA JOHNSON
Title or Position: CEO/OWNER
Credential:
Phone: 859-466-6434