=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851422620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMERITUS PROPERTIES II, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 06/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2975 JUNIPER DRIVE
-----------------------------------------------------
City | LEWISTON
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-746-8676
-----------------------------------------------------
Fax | 208-746-9843
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6737 W WASHINGTON ST STE 2300
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53214-5650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-918-5000
-----------------------------------------------------
Fax | 206-357-7292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR VICE PRESIDENT
-----------------------------------------------------
Name | JOANNE LESKOWICZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-918-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | RC-595
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------