Revera (Delaware) LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1369 Issued in WA

Legal business name

REVERA (DELAWARE) LLC

Doing business as

Montesano Health and Rehabilitation Center

Practice address

800 N. Medcalf
Montesano, WA 98563-1318

Phone

(360) 249-2273

Fax

(360) 249-2363

NPI assigned

Oct 11, 2005

Organization subpart

No

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

Authorized official

Name

Carole M Scillia

Title

LLC Manager

Phone

(203) 608-6100

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Montesano Health and Rehabilitation Center Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305849600000",
    "number": "1245228444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 PRESTON AVE",
            "address_2": "SUITE 270",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064504851",
            "telephone_number": "203-608-6100",
            "fax_number": "203-639-3574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 N. MEDCALF",
            "city": "MONTESANO",
            "state": "WA",
            "postal_code": "985631318",
            "telephone_number": "360-249-2273",
            "fax_number": "360-249-2363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERA (DELAWARE) LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2011-05-20",
        "status": "A",
        "authorized_official_last_name": "SCILLIA",
        "authorized_official_first_name": "CAROLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "LLC MANAGER",
        "authorized_official_telephone_number": "203-608-6100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "050005680",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "1369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4113692",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Montesano Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Barbara Peoples, RN
• Lisa Lynn Rager, LPN
• Ruth Anne Rasmussen
• Laura Katherine Raykowski, ARNP
• Jeri Lyn Reinertsen, OTR/L
• Scot M Reyes, OTL
• Cheryl Richter, PHARM D
• Mark Allen Robbins, PTA
• Shadley Roberts, LMT
• Katherine Rockett

• Skilled Nursing Facility in Montesano, WA
• Providers in Montesano, 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 May 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.