MEDICARE: LIFE ESSENTIALS HOME CARE LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1629799697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE ESSENTIALS HOME CARE LLC.

Provider Business Mailing Address
First Line	:	1849 FAIRMOUNT AVE
Second Line	:	P.O. BOX 121304 COVINGTON KENTUCKY 41012
City	:	CINCINNATI
State	:	OH
Zip	:	45214-1265
Country	:	US
Telephone Number	:	859-466-6434
Fax Number	:

Provider Business Practice Location Address
First Line	:	1849 FAIRMOUNT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45214-1265
Country	:	US
Telephone Number	:	859-466-6434
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MS. INDIA JOHNSON
Credential	:
Telephone Number	:	859-466-6434

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	09/08/2022

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