Provider Demographics
NPI:1124806013
Name:ESSENCE OF LIFE THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:ESSENCE OF LIFE THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-795-5519
Mailing Address - Street 1:7 DEMARET CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-1808
Mailing Address - Country:US
Mailing Address - Phone:609-857-1582
Mailing Address - Fax:
Practice Address - Street 1:7 DEMARET CT
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-1808
Practice Address - Country:US
Practice Address - Phone:609-857-1582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty