Provider Demographics
NPI:1932977055
Name:ADDIE'S COTTAGE SENIOR LIVING, INC.
Entity Type:Organization
Organization Name:ADDIE'S COTTAGE SENIOR LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-248-7222
Mailing Address - Street 1:100 S NORMANDY CT
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-3625
Mailing Address - Country:US
Mailing Address - Phone:714-248-7222
Mailing Address - Fax:714-248-7222
Practice Address - Street 1:2582 E SEVILLE AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-3111
Practice Address - Country:US
Practice Address - Phone:714-248-7222
Practice Address - Fax:714-248-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility