Basic Information
Provider Information
NPI: 1164750717
EntityType: 2
ReplacementNPI:  
OrganizationName: PAINTED POST, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: PERINTON PARK MANOR
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3131 ELLIOTT AVE
Address2: SUITE 500
City: SEATTLE
State: WA
PostalCode: 981211044
CountryCode: US
TelephoneNumber: 2062982909
FaxNumber: 2063014500
Practice Location
Address1: 7 CHARDONNAY DR
Address2:  
City: FAIRPORT
State: NY
PostalCode: 144504100
CountryCode: US
TelephoneNumber: 5854250210
FaxNumber: 5854250213
Other Information
ProviderEnumerationDate: 11/19/2009
LastUpdateDate: 11/19/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BICKEL
AuthorizedOfficialFirstName: NOELLE
AuthorizedOfficialMiddleName: DIAZ
AuthorizedOfficialTitleorPosition: LICENSING SPECIALIST
AuthorizedOfficialTelephone: 2062982909
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
310400000X370-F-221NYY Nursing & Custodial Care FacilitiesAssisted Living Facility 

No ID Information.


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