The Terrace at Beverly Lake MC GR, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

THE TERRACE AT BEVERLY LAKE MC GR, LLC

Doing business as

Terrace at Beverly Lake

Practice address

524 75TH St SE
Everett, WA 98203-5512

Phone

(425) 348-8800

NPI assigned

Jun 22, 2020

Last updated

Jun 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gregory Roderick

Title

Member

Phone

(503) 443-1818

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Terrace at Beverly Lake Doing business as

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592784000000",
    "number": "1922624311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7420 SW BRIDGEPORT RD STE 105",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972247790",
            "telephone_number": "503-597-4906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 75TH ST SE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982035512",
            "telephone_number": "425-348-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE TERRACE AT BEVERLY LAKE MC GR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-22",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A",
        "authorized_official_last_name": "RODERICK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "503-443-1818"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202779",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Terrace at Beverly Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Everett, WA
• Providers in Everett, WA by specialty
• Assisted Living Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2020; 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.