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General NPI Number Information
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NPI Number | 1982747499
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Entity Type | Organization
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Legal Business Name | ESTES LIVING EASY GROUP HOME
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 135 SALLIE DR
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City | WARRENTON
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State | NC
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Zip | 27589-8667
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Country | US
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Telephone | 252-257-1646
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Fax |
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Provider Business Mailing Address
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Address Line | 4051 RIDGEWAY DR
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City | FRANKLINTON
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State | NC
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Zip | 27525-7534
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SABRINA MICHELE RAGLAND
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Credential |
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Telephone | 919-618-3127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | MHL093044
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License Number State | NC
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