Evergreen Oregon Healthcare Orchards Rehabilitation, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1888 Issued in OR

Legal business name

EVERGREEN OREGON HEALTHCARE ORCHARDS REHABILITATION, L.L.C.

Practice address

120 Elzora St
Milton Freewater, OR 97862-9454

Phone

(541) 938-3318

Fax

(541) 938-4657

NPI assigned

May 4, 2006

Organization subpart

Yes

Parent organization

EMPRES OREGON 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

• Milton Freewater Health and Rehabilitation Center 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": "1407804198",
    "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": "120 ELZORA ST",
            "city": "MILTON FREEWATER",
            "state": "OR",
            "postal_code": "978629454",
            "telephone_number": "541-938-3318",
            "fax_number": "541-938-4657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN OREGON HEALTHCARE ORCHARDS REHABILITATION, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMPRES OREGON 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": "OR",
            "license": "1888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "801048",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Milton Freewater Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Johanna Decleene, QMHA
• John Edward Destito, PHARMD
• Dynamic Edge Physical Therapy LLC
• Edson R Brewer
• Dinah Estraza Estrellanes, PT
• Evergreen Oregon Healthcare Orchards Retirement, L.L.C.
• Fire Inc
• Virginia Foreman, SLP
• Fresenius Medical Care Dialysis Services - Oregon, LLC
• Scott T Fry, M.D.

• Skilled Nursing Facility in Milton Freewater, OR
• Providers in Milton Freewater, OR by specialty
• Skilled Nursing Facility in Oregon

• 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.