Provider Demographics
NPI:1932474103
Name:EMERICARE SKYLYN PLACE LLC
Entity Type:Organization
Organization Name:EMERICARE SKYLYN PLACE LLC
Other - Org Name:EMERITUS AT SKYLYN PLACE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER, SECRETARY, EVP
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-438-2885
Mailing Address - Street 1:3131 ELLIOTT AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1031
Mailing Address - Country:US
Mailing Address - Phone:206-298-2909
Mailing Address - Fax:206-301-4500
Practice Address - Street 1:1705 SKYLYN DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1077
Practice Address - Country:US
Practice Address - Phone:864-582-6838
Practice Address - Fax:864-582-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility