NPIMap

Organization Active NPI

Emeritus Corporation

Doing business as The Peridot Assisted Living Community

  • Assisted Living Facility
  • Prescott, AZ
National Provider Identifier
1396005195
Registry record updated May 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL8058C Issued in AZ
Legal business name
EMERITUS CORPORATION
Doing business as
The Peridot Assisted Living Community
Practice address
211 Bradshaw Dr
Prescott, AZ 86303-4405
Phone
(928) 777-5511
Fax
(928) 777-2155
NPI assigned
May 25, 2012
Last updated
May 25, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2012

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

Authorized official

Name
Tracy Allen
Title
Director Medicaid Services
Phone
(214) 701-7249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL8058C AZ Primary

Addresses

Primary practice location

211 Bradshaw Dr
Prescott, AZ 86303-4405

Mailing address

3131 Elliott Ave
Suite 500
Seattle, WA 98121-1044
Phone (206) 298-2909

Other names 1

  • The Peridot Assisted Living Community Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Emeritus Properties Ixllc236 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 11

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

NPI Registry JSON

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

{
    "created_epoch": "1337904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337904000000",
    "number": "1396005195",
    "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": "206-357-7292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 BRADSHAW DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863034405",
            "telephone_number": "928-777-5511",
            "fax_number": "928-777-2155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERITUS CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-25",
        "last_updated": "2012-05-25",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "DIRECTOR MEDICAID SERVICES",
        "authorized_official_telephone_number": "214-701-7249"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "AL8058C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Peridot Assisted Living Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2012; 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.