Provider Demographics
NPI:1023779725
Name:ESSENTIAL LAB LLC
Entity type:Organization
Organization Name:ESSENTIAL LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARDENEY
Authorized Official - Middle Name:TAJON
Authorized Official - Last Name:MANERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-374-3438
Mailing Address - Street 1:3315 LANSING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-3428
Mailing Address - Country:US
Mailing Address - Phone:314-514-5166
Mailing Address - Fax:314-932-0933
Practice Address - Street 1:3315 LANSING DR
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-3428
Practice Address - Country:US
Practice Address - Phone:314-514-5166
Practice Address - Fax:314-932-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion