Evergreen Washington Healthcare Auburn, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1269 Issued in WA

Legal business name

EVERGREEN WASHINGTON HEALTHCARE AUBURN, L.L.C.

Doing business as

Canterbury House

Practice address

502 29TH St SE
Auburn, WA 98002-7532

Phone

(253) 939-0090

Fax

(253) 939-0095

NPI assigned

May 4, 2006

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 1

Other names 1

• Canterbury House Doing business as

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1235187931",
    "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": "502 29TH ST SE",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980027532",
            "telephone_number": "253-939-0090",
            "fax_number": "253-939-0095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN WASHINGTON HEALTHCARE AUBURN, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMPRES WASHINGTON HEALTHCARE, LLC",
        "enumeration_date": "2006-05-04",
        "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": "1269",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4112694",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canterbury House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alison Evans
• Tanja D Evans, M.D.
• Cidney Jordan Evanson
• Evergreen Eye Center, PLLC
• Evergreen Psychiatry PLLC
• Kelsey Joan Evins, ATC
• Extendicare North Auburn Rehabilitation
• Sherese Danielle Ezelle
• Vinesa Faaogea-Kabui
• Emily Faber

• Skilled Nursing Facility in Auburn, WA
• Providers in Auburn, 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.