MEDICARE: SUMMERVILLE AT LAKELAND HILLS ASSOCIATES, LP

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	310400000X	Assisted Living Facility	000851	TX

General Provider Information

NPI Number	:	1962667766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMERVILLE AT LAKELAND HILLS ASSOCIATES, LP

Provider Business Mailing Address
First Line	:	3131 ELLIOTT AVE.,
Second Line	:	SUITE 500
City	:	SEATTLE
State	:	WA
Zip	:	98121-1032
Country	:	US
Telephone Number	:	206-298-2909
Fax Number	:	206-301-4500

Provider Business Practice Location Address
First Line	:	3305 DILIDO RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-8337
Country	:	US
Telephone Number	:	214-321-7300
Fax Number	:	214-347-8027

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

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	10/15/2009

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