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SUMMERVILLE 2 LLC NPI 1790011765


NPI Information

NPI: 1790011765
Provider Name: SUMMERVILLE 2, LLC

Doing Business As: BRENTWOOD AT LAPORTE

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 15D0959639

Address:
2002 ANDREW AVE
LA PORTE, IN
ZIP 46350
Phone: (219) 325-1599
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SUMMERVILLE 2, LLC is an assisted living facility in La Porte, IN. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. SUMMERVILLE 2, LLC NPI is 1790011765. The provider is registered as an organization entity type.
The provider Is Doing Business As Brentwood At Laporte.

The provider's business location address is:

2002 ANDREW AVE
LA PORTE, IN
ZIP 46350-545
Phone: (219) 325-1599
Fax: (219) 362-1682

The provider's authorized official is Noelle Diaz Bickel .
The authorized official title is Licensing Specialist and has the following contact phone number (206) 298-2909.

The CLIA number assigned to this NPI record is 15D0959639 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/27/2009 and was last updated on 10/27/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living Facility07-010890-1INDIANAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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