1063261519 NPI number — PICKERINGTON ASSISTED LIVING OPCO LLC

Table of content: (NPI 1063261519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063261519 NPI number — PICKERINGTON ASSISTED LIVING OPCO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PICKERINGTON ASSISTED LIVING OPCO 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:
Provider Other Organization Name Type Code:
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:
1063261519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5101 NE 82ND AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98662-6343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-254-9442
Provider Business Mailing Address Fax Number:
360-254-1770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 HILL RD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PICKERINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43147-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-384-0100
Provider Business Practice Location Address Fax Number:
217-384-2963
Provider Enumeration Date:
05/16/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSING COORDINATOR
Authorized Official Telephone Number:
564-203-3620

Provider Taxonomy Codes

  • Taxonomy code: 311500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com