Basic Information
Provider Information
NPI: 1851863633
EntityType: 2
ReplacementNPI:  
OrganizationName: BRITTON ASSISTED LIVING, LLC
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Mailing Information
Address1: 4601 NE 77TH AVE STE 300
Address2:  
City: VANCOUVER
State: WA
PostalCode: 986626736
CountryCode: US
TelephoneNumber: 3608926628
FaxNumber: 3608825793
Practice Location
Address1: 1311 VANDER HORCK ST
Address2:  
City: BRITTON
State: SD
PostalCode: 574302254
CountryCode: US
TelephoneNumber: 6054482251
FaxNumber: 6054485583
Other Information
ProviderEnumerationDate: 12/18/2018
LastUpdateDate: 12/18/2018
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: MILLER
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName: J.
AuthorizedOfficialTitleorPosition: CFO AND ASSISTANT MANAGER
AuthorizedOfficialTelephone: 3608926628
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: EMPRES SOUTH DAKOTA HEALTHCARE, LLC
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
310400000X  Y Nursing & Custodial Care FacilitiesAssisted Living Facility 

No ID Information.


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