Provider Demographics
NPI:1730847542
Name:LILO LLC
Entity type:Organization
Organization Name:LILO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-645-2817
Mailing Address - Street 1:4216 SW STONEY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4820
Mailing Address - Country:US
Mailing Address - Phone:573-645-2817
Mailing Address - Fax:
Practice Address - Street 1:520 NE COLBERN RD # 200
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4711
Practice Address - Country:US
Practice Address - Phone:573-434-2267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty