MEDICARE: EMERITUS CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311500000X	Alzheimer Center (Dementia Center)	486801162	CA
2	310400000X	Assisted Living Facility	486801162	CA

General Provider Information

NPI Number	:	1740518000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERITUS CORPORATION

Provider Business Mailing Address
First Line	:	3131 ELLIOTT AVE STE 500
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98121-1032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 CHERRY HILLS CT
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-7836
Country	:	US
Telephone Number	:	707-425-3588
Fax Number	:

Authorized Official
Title or Position	:	LICENSING SPECIALIST
Name	:	NOELLE BICKEL
Credential	:
Telephone Number	:	206-298-2909

Provider Enumeration Date	:	11/25/2009
Last Update Date	:	11/25/2009

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Directions to “EMERITUS CORPORATION ” Practice Location

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