Organization Active NPI

Kellog of Cascadia, LLC

Doing business as Mountain Valley of Cascadia

  • Skilled Nursing Facility
  • Kellogg, ID
National Provider Identifier
1396261202
Registry record updated May 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
KELLOG OF CASCADIA, LLC
Doing business as
Mountain Valley of Cascadia
Practice address
601 W Cameron Ave
Kellogg, ID 83837-2004
Phone
(208) 784-1283
NPI assigned
Aug 22, 2017
Last updated
May 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2024

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

Authorized official

Name
Owen Hammond
Title
President
Phone
(208) 401-9600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X ID Primary

Addresses

Primary practice location

601 W Cameron Ave
Kellogg, ID 83837-2004

Mailing address

408 S Eagle Rd Ste 205
Eagle, ID 83616-6079
Phone (208) 401-9600

Other names 1

  • Mountain Valley of Cascadia Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171106001603 ID Part A Provider - Skilled Nursing Facility 3274899364 Practice locations: Kellogg, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396261202. Details of each certification follow.

Skilled nursing facility certification: CCN 135065

Legal name
KELLOG OF CASCADIA LLC
Doing business as
MOUNTAIN VALLEY OF CASCADIA
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 1, 1979
Last certification
May 1, 2025
Beds
68
Ownership / control type
Corporation
Multi-facility organization
Cascadia Healthcare
Most recent change of ownership
Sep 1, 2017
Organization structure
LLCProprietary
Enrollment address
601 W Cameron Ave
Kellogg, ID 83837-2004
Nursing home name
MOUNTAIN VALLEY OF CASCADIA
Affiliated entity
CASCADIA HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Mountain Valley of CascadiaCCN 135065 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Sep 1, 1979
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6860.3 residents per day on average
Chain
Cascadia Healthcare46 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D0933598Mountain Valley of Cascadia601 W Cameron Ave, Kellogg, ID 83837Certificate of waiverSep 15, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Cascadia Services LLC Organization, Eagle, ID LLC Operational/Managerial Control Nov 22, 2024
Adp of the SNF Jan 23, 2025
Cascadia HC Group LLC Organization, Eagle, ID LLC Operational/Managerial Control Jun 5, 2025
Indirect Ownership Interest Jun 5, 2025 100%
Emilee Kulin Individual Operational/Managerial Control Sep 1, 2019
Adp of the SNF Jun 18, 2025
Cascadia Healthcare LLC Organization, Eagle, ID LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Sep 1, 2017
Operational/Managerial Control Sep 1, 2017
Indirect Ownership Interest Sep 1, 2017 100%
Stephen J Laforte Individual Operational/Managerial Control Jun 5, 2025
Indirect Ownership Interest Jun 5, 2025 33.33%
Owen C Hammond Individual Operational/Managerial Control Jun 5, 2025
Indirect Ownership Interest Sep 1, 2017 33.34%
White Oak Healthcare Finance LLC Organization, New York, NY LLC, Financial institution, Owned by another organization or individual 5% Or Greater Security Interest Aug 11, 2022
Michael G Meza Individual Operational/Managerial Control Jul 1, 2018
Adp of the SNF Feb 26, 2025
Cascadia Holdco LLC Organization, Eagle, ID LLC Operational/Managerial Control Jun 5, 2025
Indirect Ownership Interest Jun 5, 2025 100%
Cascadia Idaho Operations LLC Organization, Eagle, ID LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 1, 2017
Operational/Managerial Control Jun 5, 2025
Direct Ownership Interest Sep 1, 2017 100%
Timothy Nelson Individual Operational/Managerial Control Jun 5, 2025
Indirect Ownership Interest Jun 5, 2025 33.33%
Timberline Ctre Tenant LLC Organization, New York, NY LLC, Owned by another organization or individual 5% Or Greater Security Interest Jun 5, 2025 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 46

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 46

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716508800000",
    "number": "1396261202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 S EAGLE RD STE 205",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166079",
            "telephone_number": "208-401-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W CAMERON AVE",
            "city": "KELLOGG",
            "state": "ID",
            "postal_code": "838372004",
            "telephone_number": "208-784-1283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLOG OF CASCADIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-22",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A",
        "authorized_official_last_name": "HAMMOND",
        "authorized_official_first_name": "OWEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-401-9600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mountain Valley of Cascadia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kellogg, ID

Sources for this page

Verify at the official NPI Registry.