Washougal Assisted Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

BH1521 Issued in WA

Legal business name

WASHOUGAL ASSISTED LIVING, LLC

Practice address

2300 W 9TH St
Washougal, WA 98671-7437

Phone

(360) 335-1238

Fax

(360) 833-0615

NPI assigned

Apr 17, 2007

Organization subpart

No

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

Authorized official

Name

Richard Taylor

Title

Executive Director

Phone

(360) 335-1238

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Columbia Ridge Assisted Living, LLC Doing business as

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235355454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4610 NE 77TH AVE",
            "address_2": "SUITE 132",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626789",
            "telephone_number": "360-449-4524",
            "fax_number": "360-449-4525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 W 9TH ST",
            "city": "WASHOUGAL",
            "state": "WA",
            "postal_code": "986717437",
            "telephone_number": "360-335-1238",
            "fax_number": "360-833-0615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHOUGAL ASSISTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "360-335-1238"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WA",
            "license": "BH1521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "465651",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Columbia Ridge Assisted Living, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Annie Vo, PHARMD
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• All providers in Washougal, WA
• Assisted Living Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.