Healthcare Provider Details

I. General information

NPI: 1871558759
Provider Name (Legal Business Name): LIFE ESSENTIALS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 RIVERSIDE DR SUITE 100
DAYTON OH
45405-4977
US

IV. Provider business mailing address

123 RIVERSIDE DR SUITE 100
DAYTON OH
45405-4977
US

V. Phone/Fax

Practice location:
  • Phone: 937-586-0545
  • Fax: 937-586-0565
Mailing address:
  • Phone: 937-586-0545
  • Fax: 937-586-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHERINE B DIERKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 937-586-0545