Provider Demographics
NPI:1477867729
Name:EMERITUS CORPORATION
Entity Type:Organization
Organization Name:EMERITUS CORPORATION
Other - Org Name:BROOKDALE BUCKINGHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:LESKOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-918-5000
Mailing Address - Street 1:1824 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1832
Mailing Address - Country:US
Mailing Address - Phone:860-647-1695
Mailing Address - Fax:
Practice Address - Street 1:1824 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1832
Practice Address - Country:US
Practice Address - Phone:860-647-1695
Practice Address - Fax:860-647-8549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE SENIOR LIVING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-28
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT155OtherCT DEPT OF PUBLIC HEALTH
CT8024243Medicaid