Basic Information
Provider Information
NPI: 1205964640
EntityType: 2
ReplacementNPI:  
OrganizationName: ESC III LP
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: EMERITUS AT AMBER OAKS
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6737 W WASHINGTON ST
Address2: SUITE 2300
City: MILWAUKEE
State: WI
PostalCode: 532145647
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 4415 RIO D ORO
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782336748
CountryCode: US
TelephoneNumber: 2106533132
FaxNumber: 2106539791
Other Information
ProviderEnumerationDate: 02/28/2007
LastUpdateDate: 05/18/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: RICHARDSON
AuthorizedOfficialFirstName: BRYAN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: EVP, CHIEF ADMIN. OFFICER
AuthorizedOfficialTelephone: 6155648131
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
310400000X117213TXY Nursing & Custodial Care FacilitiesAssisted Living Facility 

ID Information
IDTypeStateIssuerDescription
00087010005TX MEDICAID


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