1790908689 NPI number — EMERITUS PROPERTIES NGH, LLC

Table of content: (NPI 1790908689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790908689 NPI number — EMERITUS PROPERTIES NGH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERITUS PROPERTIES NGH, 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:
BROOKDALE NORTH MESA
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:
1790908689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2122 E BROWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85213-5200
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:
2122 EAST BROWN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85213-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-298-2909
Provider Business Practice Location Address Fax Number:
206-301-4500
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LESKOWICZ
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
414-918-5000

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  ALC4036 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: ALC-4036 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 700122 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com