Provider Demographics
NPI:1124354360
Name:SUMMERVILLE AT CAMELOT PLACE LLC
Entity type:Organization
Organization Name:SUMMERVILLE AT CAMELOT PLACE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-298-2909
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 1:49 LEISURE LN
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1285
Practice Address - Country:US
Practice Address - Phone:330-723-5825
Practice Address - Fax:330-722-7039
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMERVILLE SENIOR LIVING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2357R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility