Summerville at Fairwood Manor, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SUMMERVILLE AT FAIRWOOD MANOR, LLC

Practice address

200 N Dale Ave
Anaheim, CA 92801-4897

Phone

(714) 761-5771

NPI assigned

Dec 28, 2009

Organization subpart

Yes

Parent organization

SUMMERVILLE AT COBBCO, 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 Bickel

Title

Licensing Specialist

Phone

(206) 298-2909

Specialties & licenses 1

Addresses

Other names 1

• Emeritus at Fairwood Manor Doing business as

Part of

Summerville at Cobbco Inc

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

{
    "created_epoch": "1261958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261958400000",
    "number": "1609106590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 ELLIOTT AVE STE 500",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981211032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N DALE AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928014897",
            "telephone_number": "714-761-5771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERVILLE AT FAIRWOOD MANOR, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMMERVILLE AT COBBCO, INC.",
        "enumeration_date": "2009-12-28",
        "last_updated": "2009-12-28",
        "status": "A",
        "authorized_official_last_name": "BICKEL",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emeritus at Fairwood Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.