1528000825 NPI number — ACTS RETIREMENT-LIFE COMMUNITIES, INC.

Table of content: (NPI 1528000825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528000825 NPI number — ACTS RETIREMENT-LIFE COMMUNITIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTS RETIREMENT-LIFE COMMUNITIES, INC.
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:
WILLOWBROOKE COURT AT LANIER VILLAGE ESTATES
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:
1528000825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 DELAWARE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19034-2711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-661-8330
Provider Business Mailing Address Fax Number:
215-661-8316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 VILLAGE VIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30506-4331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-450-3000
Provider Business Practice Location Address Fax Number:
678-450-1523
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AHERN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP, CFO
Authorized Official Telephone Number:
215-661-8330

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  1-069-1740 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 10691740 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 582440835 . This is a "TRI-CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 582440835 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com