Provider Demographics
NPI:1336376466
Name:SUMMERVILLE I, LLC
Entity Type:Organization
Organization Name:SUMMERVILLE I, LLC
Other - Org Name:SUMMERVILLE AT WOODWARD ESTATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-301-4060
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:98121-1044
Mailing Address - Country:US
Mailing Address - Phone:206-298-2909
Mailing Address - Fax:206-301-4500
Practice Address - Street 1:14997 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1082
Practice Address - Country:US
Practice Address - Phone:301-464-4400
Practice Address - Fax:301-464-4380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMERVILLE SENIOR LIVING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16AL0748310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility