1194936898 NPI number — SUMMERVILLE OF ATHERTON COURT

Table of content: (NPI 1194936898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194936898 NPI number — SUMMERVILLE OF ATHERTON COURT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMERVILLE OF ATHERTON COURT
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:
EMERITUS AT ATHERTON COURT
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:
1194936898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3131 ELLIOTT AVE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98121-1302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-298-2909
Provider Business Mailing Address Fax Number:
206-301-4500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38035 MARTHA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94536-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-797-4011
Provider Business Practice Location Address Fax Number:
510-797-4095
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ
Authorized Official First Name:
NOELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSING SPECIALIST
Authorized Official Telephone Number:
206-301-4060

Provider Taxonomy Codes

  • Taxonomy code: 311500000X , with the licence number:  015601255 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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