Basic Information
Provider Information
NPI: 1285841205
EntityType: 2
ReplacementNPI:  
OrganizationName: ESC - SILVERDALE, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: EMERITUS OAKS
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3131 ELLIOTT AVE STE 500
Address2:  
City: SEATTLE
State: WA
PostalCode: 981211032
CountryCode: US
TelephoneNumber: 2062982909
FaxNumber: 2063014500
Practice Location
Address1: 1501 NW TOWER VIEW CIR
Address2:  
City: SILVERDALE
State: WA
PostalCode: 983838674
CountryCode: US
TelephoneNumber: 3606974488
FaxNumber: 3606974771
Other Information
ProviderEnumerationDate: 05/17/2007
LastUpdateDate: 09/09/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DIAZ
AuthorizedOfficialFirstName: NOELLE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: LICENSING SPECIALIST
AuthorizedOfficialTelephone: 2063014060
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
311500000XBH1669WAY Nursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center) 

No ID Information.


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