Healthcare Provider Details

I. General information

NPI: 1700680758
Provider Name (Legal Business Name): SAUCE LYFE STILE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5245 SHASTA AVE
DAYTON OH
45417-9115
US

IV. Provider business mailing address

5245 SHASTA AVE
DAYTON OH
45417-9115
US

V. Phone/Fax

Practice location:
  • Phone: 937-684-5593
  • Fax:
Mailing address:
  • Phone: 937-684-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LASHONDA PARSON
Title or Position: OWNER
Credential:
Phone: 937-684-5593