Provider Demographics
NPI:1336442870
Name:EMERALD ISLE ASSISTED LIVING, INC.
Entity Type:Organization
Organization Name:EMERALD ISLE ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-378-2270
Mailing Address - Street 1:520 PALOS VERDES BLVD
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6515
Mailing Address - Country:US
Mailing Address - Phone:310-378-2270
Mailing Address - Fax:310-373-5338
Practice Address - Street 1:27781 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-3401
Practice Address - Country:US
Practice Address - Phone:310-351-7075
Practice Address - Fax:310-373-5338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198202539310400000X
CA198201753310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility