NPIMap

Organization Active NPI

Clarkston of Cascadia, LLC

  • Skilled Nursing Facility
  • Clarkston, WA
National Provider Identifier
1417523887
Registry record updated May 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CLARKSTON OF CASCADIA, LLC
Practice address
1242 11TH St
Clarkston, WA 99403-2815
Phone
(208) 401-9600
NPI assigned
May 27, 2021
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 NU Primary

Addresses

Primary practice location

1242 11TH St
Clarkston, WA 99403-2815

Mailing address

2205 E Riverside Dr Ste 100
Eagle, ID 83616-7621
Phone (208) 401-9600

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 WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211101001010 WA Part A Provider - Skilled Nursing Facility 3375931926 Practice locations: Clarkston, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417523887. Details of each certification follow.

Skilled nursing facility certification: CCN 505283

Legal name
CLARKSTON OF CASCADIA, LLC
Doing business as
CLARKSTON HEALTH AND REHABILITATION OF CASCADIA
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1984
Last certification
Jan 26, 2024
Beds
90
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Cascadia Healthcare Services
Organization structure
LLCProprietary
Enrollment address
1242 11TH St
Clarkston, WA 99403-2815
Nursing home name
CLARKSTON HEALTH AND REHAB OF CASCADIA
Affiliated entity
CASCADIA HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Clarkston Health and Rehab of CascadiaCCN 505283 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 1, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9081.8 residents per day on average
Chain
Cascadia Healthcare46 facilities in the chain
Penalties (3 years)
1Fines totaling $32,711

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
50D2252747Clarkston Health and Rehabilitation of Cascadia1242 11TH St, Clarkston, WA 99403Certificate of waiverApr 4, 2028

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
Andrew Schiller Individual Operational/Managerial Control Sep 5, 2021
Adp of the SNF Feb 18, 2025
Cascadia Services LLC Organization, Eagle, ID LLC Operational/Managerial Control May 28, 2021
Adp of the SNF Jan 13, 2025
Cascadia HC Group LLC Organization, Eagle, ID LLC, Owned by another organization or individual Indirect Ownership Interest Jun 5, 2025 100%
John Bradley Rudolph Individual Operational/Managerial Control Jul 4, 2025
Adp of the SNF Jul 14, 2025
Cascadia Healthcare LLC Organization, Eagle, ID LLC, Owned by another organization or individual Indirect Ownership Interest Dec 1, 2021 100%
Stephen J Laforte Individual Operational/Managerial Control Jun 5, 2025
Indirect Ownership Interest Jun 5, 2025 33.33%
Cascadia Washington Operations LLC Organization, Eagle, ID LLC, Owned by another organization or individual Direct Ownership Interest Dec 1, 2021 100%
Owen C Hammond Individual Operational/Managerial Control Dec 1, 2021
Indirect Ownership Interest Dec 1, 2021 33.34%
Timberline Ohi Tenant LLC Organization, New York, NY LLC, Owned by another organization or individual 5% Or Greater Security Interest Jun 5, 2025 100%
Adp of the SNF Jun 5, 2025
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 100%
Cascadia Holdco LLC Organization, Eagle, ID LLC, Owned by another organization or individual Indirect Ownership Interest Jun 5, 2025 100%
Timothy Nelson Individual Operational/Managerial Control Jun 5, 2025
Indirect Ownership Interest Jun 5, 2025 33.33%

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 44

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

View all 44

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": "1622073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716508800000",
    "number": "1417523887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 E RIVERSIDE DR STE 100",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836167621",
            "telephone_number": "208-401-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1242 11TH ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032815",
            "telephone_number": "208-401-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSTON OF CASCADIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-27",
        "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": "NU",
            "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": []
}

Other providers in Clarkston, WA

Sources for this page

Verify at the official NPI Registry.