NPIMap

Organization Active NPI

Brea Emeritus LLC

Doing business as Brookdale Trail Ridge

  • Alzheimer Center (Dementia Center)
  • Sun City West, AZ
National Provider Identifier
1194947887
Registry record updated Jul 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Alzheimer Center (Dementia Center)Taxonomy code 311500000X
Legal business name
BREA EMERITUS LLC
Doing business as
Brookdale Trail Ridge
Practice address
21739 N 151St Ave
Sun City West, AZ 85375-6150
Phone
(623) 546-3650
Fax
(623) 546-3740
NPI assigned
May 3, 2007
Last updated
Jul 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2023

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

Authorized official

Name
Joanne K Leskowicz
Title
Senior Vice President
Phone
(414) 918-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Alzheimer Center (Dementia Center) 311500000X Primary

Addresses

Primary practice location

21739 N 151St Ave
Sun City West, AZ 85375-6150

Mailing address

21739 N 151St Ave
Sun City West, AZ 85375-6150
Phone (623) 546-3650

Other identifiers 1

IdentifierTypeStateIssuer
215213MedicaidAZ

Other names 1

  • Brookdale Trail Ridge Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D0945168Brookdale Trail Ridge21739 N 151St Avenue, Sun City West, AZ 85375Certificate of waiverApr 26, 2028

National Provider Directory

National Provider Directory
Tax ID family
Brea Palmer Ranch LLC25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689638400000",
    "number": "1194947887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21739 N 151ST AVE",
            "city": "SUN CITY WEST",
            "state": "AZ",
            "postal_code": "853756150",
            "telephone_number": "623-546-3650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21739 N 151ST AVE",
            "city": "SUN CITY WEST",
            "state": "AZ",
            "postal_code": "853756150",
            "telephone_number": "623-546-3650",
            "fax_number": "623-546-3740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREA EMERITUS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A",
        "authorized_official_last_name": "LESKOWICZ",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "414-918-5000"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "215213",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookdale Trail Ridge",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brookdale Trail Ridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sun City West, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.