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General NPI Number Information
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NPI Number | 1841946787
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Entity Type | Organization
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Legal Business Name | ESTEEMED SENIOR LIVING
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Dates
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Enumeration Date | 03/01/2022
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 2101 DIANE DR
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City | PLANO
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State | TX
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Zip | 75074-3545
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Country | US
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Telephone | 469-970-0277
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Fax |
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Provider Business Mailing Address
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Address Line | 3027 LILY LN
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City | HEATH
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State | TX
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Zip | 75126-0617
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Country | US
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Telephone | 254-229-9275
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | MR. BENNIE GRIFFIN
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Credential | LVN
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Telephone | 254-229-9275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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