Provider Demographics
NPI:1225294077
Name:EMERITUS
Entity Type:Organization
Organization Name:EMERITUS
Other - Org Name:BELLAIRE PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-675-0220
Mailing Address - Street 1:23 SOUTHPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5956
Mailing Address - Country:US
Mailing Address - Phone:864-675-0220
Mailing Address - Fax:864-675-6363
Practice Address - Street 1:23 SOUTHPOINTE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5956
Practice Address - Country:US
Practice Address - Phone:864-675-0220
Practice Address - Fax:864-675-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC1335310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRC1335Medicaid