Evergreen Washington Healthcare Enumclaw, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH1266 Issued in WA

Legal business name

EVERGREEN WASHINGTON HEALTHCARE ENUMCLAW, L.L.C.

Doing business as

Enumclaw Health and Rehabilitation Center

Practice address

2323 Jensen St
Enumclaw, WA 98022-3698

Phone

(360) 825-2541

Fax

(360) 825-4351

NPI assigned

Sep 13, 2005

Last updated

Feb 2, 2022By 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

Michael J. Miller

Title

Cfo and Assistant Manager

Phone

(360) 892-6628

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Enumclaw Health and Rehabilitation Center Doing business as

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643760000000",
    "number": "1457346785",
    "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": "2323 JENSEN ST",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980223698",
            "telephone_number": "360-825-2541",
            "fax_number": "360-825-4351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN WASHINGTON HEALTHCARE ENUMCLAW, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMPRES WASHINGTON HEALTHCARE, LLC",
        "enumeration_date": "2005-09-13",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CFO AND ASSISTANT MANAGER",
        "authorized_official_telephone_number": "360-892-6628"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "NH1266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4112660",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Enumclaw Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Enumclaw Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Enumclaw Vision Clinic PLLC
• Jennifer Marie Erickson, PA-C
• Kelli Michelle Espinosa
• Katie Etherington, CNM, WHNP-BC
• Evergreen Eye Center, PLLC (Evergreen Eye Center)
• Family Physical Therapy PLLC
• Fang Acupuncture Clinic
• Carrie Fang, L.A.
• Kelly Ferguson
• Laura Ferrel

• Skilled Nursing Facility in Enumclaw, WA
• Providers in Enumclaw, 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 Feb 2, 2022; 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.