Extendicare Homes, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

EXTENDICARE HOMES, INC.

Practice address

1015 N Garrison Rd
Vancouver, WA 98664-1313

Phone

(360) 694-7501

Fax

(360) 694-8148

NPI assigned

Nov 17, 2006

Organization subpart

No

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

Authorized official

Name

Donna Jo Maassen

Title

Director of Compliance

Phone

(414) 908-8119

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pacific Specialty and Rehabilitative Care Doing business as

Locations

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207526400000",
    "number": "1114091733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W MICHIGAN ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532032903",
            "telephone_number": "414-908-8119",
            "fax_number": "414-908-7105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 N GARRISON RD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641313",
            "telephone_number": "360-694-7501",
            "fax_number": "360-694-8148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDICARE HOMES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2008-04-07",
        "status": "A",
        "authorized_official_last_name": "MAASSEN",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "DIRECTOR OF COMPLIANCE",
        "authorized_official_telephone_number": "414-908-8119"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4110094",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Specialty and Rehabilitative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Vancouver, WA
• Providers in Vancouver, 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 Apr 7, 2008; 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.