Evergreen Kitsap, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

EVERGREEN KITSAP, L.L.C.

Doing business as

Northwoods Lodge

Practice address

2321 NW Schold PL
Silverdale, WA 98383-9504

Phone

(360) 698-8930

NPI assigned

Jan 20, 2017

Last updated

Jan 20, 2017By the provider in NPPES

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) 604-4217

Specialties & licenses 1

Addresses

Other names 1

• Northwoods Lodge Doing business as

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

{
    "created_epoch": "1484870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484870400000",
    "number": "1336686914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 NE 77TH AVE STE 300",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626736",
            "telephone_number": "360-604-4217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 NW SCHOLD PL",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983839504",
            "telephone_number": "360-698-8930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN KITSAP, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMPRES WASHINGTON HEALTHCARE, LLC",
        "enumeration_date": "2017-01-20",
        "last_updated": "2017-01-20",
        "status": "A",
        "authorized_official_last_name": "WEIL",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CEO AND MANAGER",
        "authorized_official_telephone_number": "360-604-4217"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwoods Lodge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Esc - Silverdale, LLC (Emeritus Oaks)
• Evelyn Escutin, M.D.
• Lori Patricia Essigmann, LMP
• Sandra E.D. Estrada, ARNP
• Emily Everett, DPT
• Sarah Anne Eves
• Eye Clinic of Bremerton, Inc. P.S. (Achieve Eye & Laser Specialists)
• Miranda Fabrega, DMD
• Douglas Fairbanks, L.D.O.
• Keith A Fairbanks, D.O.

• Skilled Nursing Facility in Silverdale, WA
• Providers in Silverdale, 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 20, 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.