Evergreen Washington Healthcare Frontier, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1225 Issued in WA

Legal business name

EVERGREEN WASHINGTON HEALTHCARE FRONTIER, L.L.C.

Practice address

1500 3Rd Ave
Longview, WA 98632-8632

Phone

(360) 423-8800

Fax

(360) 636-3421

NPI assigned

Sep 14, 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

• Frontier Rehabilitation and Extended Care Center Doing business as

Locations

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1104811207",
    "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": "1500 3RD AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986328632",
            "telephone_number": "360-423-8800",
            "fax_number": "360-636-3421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN WASHINGTON HEALTHCARE FRONTIER, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMPRES WASHINGTON HEALTHCARE, LLC",
        "enumeration_date": "2005-09-14",
        "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": "1225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE NH#",
            "identifier": "1225",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4112256",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Frontier Rehabilitation and Extended Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Ann Evans
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• Brandon Excell
• Kelly Anne Exner, M.A.
• John Leigh Ey, M.D.
• Eyemart Express LLC

• 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.