Provider Demographics
NPI:1871558759
Name:LIFE ESSENTIALS, INC.
Entity type:Organization
Organization Name:LIFE ESSENTIALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DIERKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-586-0545
Mailing Address - Street 1:123 RIVERSIDE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4977
Mailing Address - Country:US
Mailing Address - Phone:937-586-0545
Mailing Address - Fax:937-586-0565
Practice Address - Street 1:123 RIVERSIDE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4977
Practice Address - Country:US
Practice Address - Phone:937-586-0545
Practice Address - Fax:937-586-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10015Medicare UPIN