Organization
SUMMERVILLE AT PRINCE WILLIAM, INC
Active
Other names
Emeritus at Lake Ridge
Organization subpart
No
Provider details
NPI number
Authorized official
NOELLE DIAZ (LICENSING SPECIALIST)
(206) 298-2909
Entity
Organization
Contact information
Practice address
3940 PRINCE WILLIAM PKWY, WOODBRIDGE, VA 22192-4513
(703) 680-0600
(703) 680-0790
Mailing address
3131 ELLIOTT AVE, SUITE 500, SEATTLE, WA 98121-1032
(206) 298-2909
(206) 301-4500
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
WLO-03-780
VA
311500000X
Alzheimer Center (Dementia Center)
WLO-03-780
VA
Other
Enumeration date
05/18/2007
Last updated
09/09/2009
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