Provider Demographics
NPI:1013264613
Name:ESTEEM LIVING, LLC
Entity Type:Organization
Organization Name:ESTEEM LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:985-419-2430
Mailing Address - Street 1:PO BOX 1600
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-1600
Mailing Address - Country:US
Mailing Address - Phone:985-419-2430
Mailing Address - Fax:985-419-2431
Practice Address - Street 1:1810 CM FAGAN DRIVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401
Practice Address - Country:US
Practice Address - Phone:985-419-2430
Practice Address - Fax:985-419-2431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management