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General NPI Number Information
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NPI Number | 1023779725
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Entity Type | Organization
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Legal Business Name | ESSENTIAL LAB LLC
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 3315 LANSING DR
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City | SAINT ANN
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State | MO
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Zip | 63074-3428
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Country | US
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Telephone | 314-514-5166
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Fax | 314-932-0933
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Provider Business Mailing Address
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Address Line | 3315 LANSING DR
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City | SAINT ANN
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State | MO
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Zip | 63074-3428
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Country | US
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Telephone | 314-514-5166
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Fax | 314-932-0933
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Authorized Official
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Title or Position | CO-CEO
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Name | SHARDENEY TAJON MANERS
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Credential |
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Telephone | 314-374-3438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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