1053533224 NPI number — TEWKSBURY ASSISTED LIVING, LLC

Table of content: (NPI 1053533224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053533224 NPI number — TEWKSBURY ASSISTED LIVING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEWKSBURY ASSISTED LIVING, LLC
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:
THE ISLE AT EMERALD 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:
1053533224
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2008
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:
98121-1044
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:
2000 EMERALD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEWKSBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01876-5220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-640-0194
Provider Business Practice Location Address Fax Number:
978-640-0279
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUAY
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
603-429-0142

Provider Taxonomy Codes

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

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





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