Healthcare Provider Details

I. General information

NPI: 1215267117
Provider Name (Legal Business Name): SUMMERVILLE 8, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19850 GOLDEN SPRINGS DR
WALNUT CA
91789-3411
US

IV. Provider business mailing address

3131 ELLIOTT AVE STE 500
SEATTLE WA
98121-1032
US

V. Phone/Fax

Practice location:
  • Phone: 909-595-5030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: NOELLE BICKEL
Title or Position: LICENSING SPECIALIST
Credential:
Phone: 206-298-2909