Provider Demographics
NPI:1982747499
Name:ESTES LIVING EASY GROUP HOME
Entity type:Organization
Organization Name:ESTES LIVING EASY GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:RAGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-618-3127
Mailing Address - Street 1:4051 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27525-7534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:135 SALLIE DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589-8667
Practice Address - Country:US
Practice Address - Phone:252-257-1646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL093044320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities