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General NPI Number Information
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NPI Number | 1013264613
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Entity Type | Organization
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Legal Business Name | ESTEEM LIVING, LLC
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 1810 CM FAGAN DRIVE
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City | HAMMOND
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State | LA
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Zip | 70401
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Country | US
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Telephone | 985-419-2430
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Fax | 985-419-2431
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Provider Business Mailing Address
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Address Line | PO BOX 1600
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City | AMITE
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State | LA
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Zip | 70422-1600
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Country | US
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Telephone | 985-419-2430
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Fax | 985-419-2431
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. TABITHA TILLIS
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Credential | MBA
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Telephone | 985-419-2430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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