MEDICARE: EMERITUSCORPORATION

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	310400000X	Assisted Living Facility	032614	MO

General Provider Information

NPI Number	:	1780803221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERITUSCORPORATION

Provider Business Mailing Address
First Line	:	3131 ELLIOTT AVE
Second Line	:	SUITE500
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	:	300 AUTUMN RIDGE DR
Second Line	:
City	:	HERCULANEUM
State	:	MO
Zip	:	63048-1506
Country	:	US
Telephone Number	:	636-931-8400
Fax Number	:	636-933-3975

Authorized Official
Title or Position	:	VPO
Name	:	MR. CHRIS BELFORD
Credential	:
Telephone Number	:	214-823-5854

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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Practice Location Address:

300 AUTUMN RIDGE DR
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1639244676 — SCENIC NURSING AND REHABILITATION CENTER, LLC
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Directions to “EMERITUSCORPORATION ” Practice Location

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