Basic Information
Provider Information | |||||||||
NPI: | 1649487414 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | EMERITUS CORP. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | LOYALTON OF DANVILLE | ||||||||
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: | 432 HERMITAGE DR | ||||||||
Address2: |   | ||||||||
City: | DANVILLE | ||||||||
State: | VA | ||||||||
PostalCode: | 245415800 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4347913180 | ||||||||
FaxNumber: | 4347913378 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/17/2007 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MCCANLESS | ||||||||
AuthorizedOfficialFirstName: | SUZETTE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATIONS | ||||||||
AuthorizedOfficialTelephone: | 2299850607 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | RO-07-134 | VA | X |   | Nursing & Custodial Care Facilities | Assisted Living Facility |   | 311500000X | RO-07-134 | VA | X |   | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) |   |
No ID Information.