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General NPI Number Information
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NPI Number | 1568881704
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Entity Type | Organization
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Legal Business Name | LIVING ESSENTIALS CONSUMER DIRECTED SERVICES LLC
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 04/25/2014
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Provider Practice Location Address
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Address Line | 1515 N WARSON RD SUITE 116
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City | SAINT LOUIS
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State | MO
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Zip | 63132-1111
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Country | US
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Telephone | 314-736-4275
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Fax | 314-260-6781
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Provider Business Mailing Address
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Address Line | 1515 N WARSON RD SUITE 116
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City | SAINT LOUIS
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State | MO
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Zip | 63132-1111
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Country | US
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Telephone | 314-736-4275
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Fax | 314-260-6781
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | MRS. KENEISHIA CHAVON ELIJAH
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Credential |
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Telephone | 314-736-4275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | MO
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