1801063227 NPI number — AL INVESTORS OF PINELLAS PARK, LLC

Table of content: (NPI 1801063227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801063227 NPI number — AL INVESTORS OF PINELLAS PARK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AL INVESTORS OF PINELLAS PARK, 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:
EMERITUS AT BAYSIDE TERRACE
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:
1801063227
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:
STE 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:
206-301-4500
Provider Business Mailing Address Fax Number:
206-301-4500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9381 US HIGHWAY 19 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINELLAS PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33782-5410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-576-1234
Provider Business Practice Location Address Fax Number:
727-570-2257
Provider Enumeration Date:
05/14/2008

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: 310400000X , with the licence number:  AL6139 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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