Provider Demographics
NPI:1164730875
Name:SEAWORTHY LIFE LIVING SOLUTIONS
Entity Type:Organization
Organization Name:SEAWORTHY LIFE LIVING SOLUTIONS
Other - Org Name:SEAWORTHY LIFE LIVING SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CNA
Authorized Official - Prefix:MS
Authorized Official - First Name:TOMIKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:901-691-1433
Mailing Address - Street 1:3221 MADEWELL ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-6217
Mailing Address - Country:US
Mailing Address - Phone:901-691-1433
Mailing Address - Fax:
Practice Address - Street 1:3221 MADEWELL ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6217
Practice Address - Country:US
Practice Address - Phone:901-691-1433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health