Healthcare Provider Details

I. General information

NPI: 1992832018
Provider Name (Legal Business Name): EMERITUS PROPERTIES NGH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1765 WEST HIBISCUS BLVD
MELBOURNE FL
32901
US

IV. Provider business mailing address

6737 W WASHINGTON ST STE 2300
MILWAUKEE WI
53214-5650
US

V. Phone/Fax

Practice location:
  • Phone: 321-733-7111
  • Fax: 321-733-1412
Mailing address:
  • Phone: 414-918-5000
  • Fax: 206-301-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number9396
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number9396
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL9396
License Number StateFL

VIII. Authorized Official

Name: BRYAN RICHARDSON
Title or Position: EVP, CHIEF ADMIN. OFFICER
Credential:
Phone: 615-564-8131