Summerville at Camelot Place LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

2357R Issued in OH

Legal business name

SUMMERVILLE AT CAMELOT PLACE LLC

Practice address

49 Leisure LN
Medina, OH 44256-1285

Phone

(330) 723-5825

Fax

(330) 722-7039

NPI assigned

Oct 22, 2009

Organization subpart

Yes

Parent organization

SUMMERVILLE SENIOR LIVING, INC.As reported in NPPES

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

Authorized official

Name

Noelle D Bickel

Title

Licensing Specialist

Phone

(206) 298-2909

Specialties & licenses 1

Addresses

Other names 1

• Emeritus at Camelot Place Doing business as

Part of

Summerville at St Augustine LLC

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

{
    "created_epoch": "1256169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256169600000",
    "number": "1124354360",
    "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": "981211044",
            "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": "49 LEISURE LN",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442561285",
            "telephone_number": "330-723-5825",
            "fax_number": "330-722-7039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERVILLE AT CAMELOT PLACE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMMERVILLE SENIOR LIVING, INC.",
        "enumeration_date": "2009-10-22",
        "last_updated": "2009-10-22",
        "status": "A",
        "authorized_official_last_name": "BICKEL",
        "authorized_official_first_name": "NOELLE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "LICENSING SPECIALIST",
        "authorized_official_telephone_number": "206-298-2909"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "OH",
            "license": "2357R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emeritus at Camelot Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Summa Physicians LLC
• Summa Physicians LLC
• Summa Physicians LLC
• Summa Physicians LLC
• Desiree Summers, LPCC-S
• Jennifer Sunday, L.P.C.C.
• Denise Sundby
• Casey Surblis, M. ED., BCBA
• Surgical Associates of Medina
• Celeste Ann Survoy, PT

• Assisted Living Facility in Medina, OH
• Providers in Medina, OH by specialty
• Assisted Living Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 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.