1104952480 NPI number — ESC III LP

Table of content: (NPI 1104952480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104952480 NPI number — ESC III LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESC III LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BROOKDALE SAN MARCOS SOUTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104952480
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 WESTWOOD PL STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-221-2250
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 WONDER WORLD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78666-7555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-396-8271
Provider Business Practice Location Address Fax Number:
512-396-8273
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LESKOWICZ
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
414-918-5000

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F500153020 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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