Emeritus Corporation

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

894 Issued in MS

Legal business name

EMERITUS CORPORATION

Doing business as

Emeritus at Trace Pointe

Practice address

501 E Northside Dr
Clinton, MS 39056-3604

Phone

(601) 926-1224

Fax

(601) 926-2070

NPI assigned

Jul 1, 2008

Last updated

Oct 15, 2009By the provider in NPPES

Organization subpart

Yes

Parent organization

EMERITUS CORPORATIONAs reported in NPPES

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

Authorized official

Name

Noelle Diaz Bickel

Title

Licensing Specialist

Phone

(206) 298-2909

Specialties & licenses 1

Addresses

Other names 1

• Emeritus at Trace Pointe Doing business as

Part of

Emeritus Corporation

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

{
    "created_epoch": "1214870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255564800000",
    "number": "1699937441",
    "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": "501 E NORTHSIDE DR",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390563604",
            "telephone_number": "601-926-1224",
            "fax_number": "601-926-2070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERITUS CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMERITUS CORPORATION",
        "enumeration_date": "2008-07-01",
        "last_updated": "2009-10-15",
        "status": "A",
        "authorized_official_last_name": "BICKEL",
        "authorized_official_first_name": "NOELLE",
        "authorized_official_middle_name": "DIAZ",
        "authorized_official_title_or_position": "LICENSING SPECIALIST",
        "authorized_official_telephone_number": "206-298-2909"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MS",
            "license": "894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emeritus at Trace Pointe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shinita Reed Dudley, MD
• Stephanie Phillips Dungey, DMD
• Izoduwa Lucinda Ekunwe, NP
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• Emeritrace LLC (Brookdale Clinton)
• Kimberly Ennis
• Rhea McCann Estes, OTR
• Euphoria Home Care
• Chantel C Everett, D.M.D.
• Excell Care Rehabilitation

• Assisted Living Facility in Clinton, MS
• Providers in Clinton, MS by specialty
• Assisted Living Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.