1619192465 NPI number — EMERITUS CORPORATION

Table of content: (NPI 1619192465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619192465 NPI number — EMERITUS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERITUS CORPORATION
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:
6
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:
1619192465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6737 W WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 2300
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53214-5647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 SOUTHPOINTE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29607-5956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-675-0220
Provider Business Practice Location Address Fax Number:
864-284-9936
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP, CHIEF ADMIN. OFFICER
Authorized Official Telephone Number:
615-564-8131

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  CRC-1335 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RC1335 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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