Basic Information
Provider Information | |||||||||
NPI: | 1568746980 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BROOKDALE SENIOR LIVING COMMUNTIES INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | STERLING HOUSE OF URBANA | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 609 E WATER ST | ||||||||
Address2: |   | ||||||||
City: | URBANA | ||||||||
State: | OH | ||||||||
PostalCode: | 430787100 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9376521500 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 609 E WATER ST | ||||||||
Address2: |   | ||||||||
City: | URBANA | ||||||||
State: | OH | ||||||||
PostalCode: | 430787100 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9376521500 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/04/2011 | ||||||||
LastUpdateDate: | 10/04/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RIJOS | ||||||||
AuthorizedOfficialFirstName: | JOHN | ||||||||
AuthorizedOfficialMiddleName: | P | ||||||||
AuthorizedOfficialTitleorPosition: | CO-PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 3129773700 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | BROOKDALE SENIOR LIVING INC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 2155R | OH | Y |   | Nursing & Custodial Care Facilities | Assisted Living Facility |   |
ID Information
ID | Type | State | Issuer | Description | PENDING | 01 | OH | MEDICAID WAIVER | OTHER |