Summerville at Prince William, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

WLO-03-780 Issued in VA

Legal business name

SUMMERVILLE AT PRINCE WILLIAM, INC

Practice address

3940 Prince William Pkwy
Woodbridge, VA 22192-4513

Phone

(703) 680-0600

Fax

(703) 680-0790

NPI assigned

May 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Noelle Diaz

Title

Licensing Specialist

Phone

(206) 298-2909

Specialties & licenses 2

Addresses

Other names 1

• Emeritus at Lake Ridge Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252454400000",
    "number": "1104034412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 ELLIOTT AVE",
            "address_2": "SUITE 500",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981211032",
            "telephone_number": "206-298-2909",
            "fax_number": "206-301-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3940 PRINCE WILLIAM PKWY",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924513",
            "telephone_number": "703-680-0600",
            "fax_number": "703-680-0790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERVILLE AT PRINCE WILLIAM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2009-09-09",
        "status": "A",
        "authorized_official_last_name": "DIAZ",
        "authorized_official_first_name": "NOELLE",
        "authorized_official_title_or_position": "LICENSING  SPECIALIST",
        "authorized_official_telephone_number": "206-298-2909"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "VA",
            "license": "WLO-03-780",
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "VA",
            "license": "WLO-03-780",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emeritus at Lake Ridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maria Danielle Sugastti Balcazar, DO
• Oscar Fernando Sugastti, M.D.
• Chase Woosik Suh, DMD
• Mohammad Sabir Sultani
• Yama S Sultanzada, DDS
• Angela Michon Sumner
• Sunflowershomehealthcarellc
• Christine Sunia, DO
• Sunny Days Behavior Change
• Sunnycreditrepair

• Assisted Living Facility in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Assisted Living Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.