Provider Demographics
NPI:1104186840
Name:EVERSTEAD SENIOR LIVING LLC
Entity Type:Organization
Organization Name:EVERSTEAD SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TALBOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-484-4300
Mailing Address - Street 1:9971 QUAIL BLVD
Mailing Address - Street 2:SUITE 1107
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5134
Mailing Address - Country:US
Mailing Address - Phone:512-484-4300
Mailing Address - Fax:
Practice Address - Street 1:9971 QUAIL BLVD
Practice Address - Street 2:SUITE 1107
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5134
Practice Address - Country:US
Practice Address - Phone:512-484-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-28
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care