Provider Demographics
NPI:1457631087
Name:EDDIE LIVING INC
Entity type:Organization
Organization Name:EDDIE LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:LA'NIECE
Authorized Official - Last Name:THOMPSON-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR OF OPERATIO
Authorized Official - Phone:281-541-5318
Mailing Address - Street 1:PO BOX 671646
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77267-1646
Mailing Address - Country:US
Mailing Address - Phone:713-633-0042
Mailing Address - Fax:281-749-8228
Practice Address - Street 1:5509 WIPPRECHT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-1741
Practice Address - Country:US
Practice Address - Phone:713-633-0042
Practice Address - Fax:281-749-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1238428320600000X, 320800000X, 322D00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children