1003942129 NPI number — EMERITUS CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003942129 NPI number — EMERITUS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERITUS CORPORATION
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 EDDY POND EAST
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:
1003942129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6737 W WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 2300
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53214-5647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
667 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01501-2722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-832-2200
Provider Business Practice Location Address Fax Number:
508-832-2411
Provider Enumeration Date:
02/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP, CHIEF ADMIN. OFFICER
Authorized Official Telephone Number:
615-564-8131

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 311500000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1903489 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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