Evergreen at Park Royal II, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH1336 Issued in WA

Legal business name

EVERGREEN AT PARK ROYAL II, L.L.C.

Practice address

910 16TH Ave
Longview, WA 98632-2302

Phone

(360) 423-2890

Fax

(360) 577-9012

NPI assigned

Sep 13, 2005

Organization subpart

Yes

Parent organization

EMPRES WASHINGTON HEALTHCARE, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brent Weil

Title

Ceo and Manager

Phone

(360) 892-6628

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Park Royal Health and Rehabilitation Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1093700353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 NE 77TH AVE",
            "address_2": "SUITE 300",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626736",
            "telephone_number": "360-892-6628",
            "fax_number": "360-882-5793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 16TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322302",
            "telephone_number": "360-423-2890",
            "fax_number": "360-577-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN AT PARK ROYAL II, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMPRES WASHINGTON HEALTHCARE, LLC",
        "enumeration_date": "2005-09-13",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "WEIL",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CEO AND MANAGER",
        "authorized_official_telephone_number": "360-892-6628"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "NH1336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4113361",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE NH#",
            "identifier": "NH1336",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Royal Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kacy Christine Evans
• Lisa M. Evans, MD
• Morgan Daneel Evans, D.O
• Sarah Ann Evans
• Evergreen Americana Health and Rehabilitation Center
• Evergreen Prosthetics and Orthotics, LLC
• Evergreen Washington Healthcare Americana, L.L.C.
• Evergreen Washington Healthcare Frontier, L.L.C.
• Evergreen Washington Healthcare Manor, L.L.C.
• Brandon Excell

• Skilled Nursing Facility in Longview, WA
• Providers in Longview, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.