MEDICARE: ESC NEW PORT RICHEY, LLCEMERITUS PROPERTIES NGH LLC

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	311500000X	Alzheimer Center (Dementia Center)	AL9380	FL
2	310400000X	Assisted Living Facility	AL9380	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184832107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESC NEW PORT RICHEY, LLCEMERITUS PROPERTIES NGH LLC

Provider Business Mailing Address
First Line	:	6737 W WASHINGTON ST
Second Line	:	SUITE 2300
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-5647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6895 BELFORT OAKS PL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6242
Country	:	US
Telephone Number	:	904-296-2384
Fax Number	:	904-296-2915

Authorized Official
Title or Position	:	EVP, CHIEF ADMIN. OFFICER
Name	:	BRYAN RICHARDSON
Credential	:
Telephone Number	:	615-564-8131

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	05/13/2016

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