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NPI Code Detail

MEDICARE: ESC NEW PORT RICHEY, LLC

MEDICARE: ESC NEW PORT RICHEY, 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
1310400000XAssisted Living FacilityAL 5096FL

Other Identifiers

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

General Provider Information

NPI Number : 1649399577
Entity Type Code : Organization
Provider Name (Legal Business Name) : ESC NEW PORT RICHEY, LLC
Provider Business Mailing Address
First Line : 3131 ELLIOTT AVE
Second Line : SUITE 500
City : SEATTLE
State : WA
Zip : 98121-1044
Country : US
Telephone Number : 206-298-2909
Fax Number : 206-301-4500
Provider Business Practice Location Address
First Line : 1896 PARK MEADOWS DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-3738
Country : US
Telephone Number : 239-939-5421
Fax Number : 239-939-4751
Authorized Official
Title or Position : DIRECTOR OF MEDICAID SERVICES
Name : TRACY ALLEN
Credential :
Telephone Number : 206-298-2909
Provider Enumeration Date : 03/29/2007
Last Update Date : 08/04/2011

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Directions to “ESC NEW PORT RICHEY, LLC ” Practice Location

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