Healthcare Provider Details

I. General information

NPI: 1891605796
Provider Name (Legal Business Name): ESSENTIAL LIVING SUPPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 ALYSSAELAINE DR
CHEYENNE WY
82007-1982
US

IV. Provider business mailing address

1541 ALYSSAELAINE DR
CHEYENNE WY
82007-1982
US

V. Phone/Fax

Practice location:
  • Phone: 254-217-6669
  • Fax: 307-369-1030
Mailing address:
  • Phone: 254-217-6669
  • Fax: 307-369-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD BROWN JR.
Title or Position: OWNER
Credential:
Phone: 254-217-6669