Everett Manor, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EVERETT MANOR, LLC

Practice address

2520 Madison St
Everett, WA 98203-4868

Phone

(425) 353-4040

NPI assigned

May 15, 2024

Organization subpart

No

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

Authorized official

Name

Shmuel D Stock

Title

Managing Member

Phone

(562) 843-4843

Specialties & licenses 1

Addresses

Other names 1

• Madison Villa Doing business as

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

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1992554778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "422 S MANSFIELD AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900363516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 MADISON ST",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982034868",
            "telephone_number": "425-353-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERETT MANOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-15",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A",
        "authorized_official_last_name": "STOCK",
        "authorized_official_first_name": "SHMUEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "562-843-4843"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison Villa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Everett Denture Center PLLC
• Everett E N T PS Inc
• Everett Foot Clinic PLLC
• Everett Heritage Court
• Everett Mall Way Dental Group
• Everett MRI & Diagnostic Center LLC
• Everett Optometry Clinic, PLLC
• Everett Physical Therapy and Sport Performance Center PLLC
• Everett Post Acute, LLC
• Everett Psychiatry Associates

• 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 May 15, 2024; 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.