=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538473889
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMERITUS CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2010
-----------------------------------------------------
Last Update Date | 05/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14505 MINNETONKA DR
-----------------------------------------------------
City | MINNETONKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55345-2210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-988-0011
-----------------------------------------------------
Fax | 952-988-0151
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6737 W WASHINGTON ST SUITE 2300
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53214-5647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EVP, CHIEF ADMIN. OFFICER
-----------------------------------------------------
Name | BRYAN RICHARDSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-564-8131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------