1962619577 NPI number — EMERITUS ASSISTED LIVING

Table of content: (NPI 1962619577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962619577 NPI number — EMERITUS ASSISTED LIVING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERITUS ASSISTED LIVING
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:
HERITAGE LODGE ASSISTED LIVING
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:
1962619577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
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:
2500 HERITAGE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28791-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-693-8292
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCANLESS
Authorized Official First Name:
SUZETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
229-985-0607

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  HAL-054-010 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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