Evergreen Oregon Healthcare Valley Vista, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1668 Issued in OR

Legal business name

EVERGREEN OREGON HEALTHCARE VALLEY VISTA, L.L.C.

Doing business as

The Dalles Health and Rehabilitation Center

Practice address

1023 W 25TH St
The Dalles, OR 97058-1251

Phone

(541) 298-5158

Fax

(541) 298-3864

NPI assigned

May 4, 2006

Last updated

Jan 30, 2017By the provider in NPPES

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

• The Dalles 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": "1487602173",
    "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": "1023 W 25TH ST",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970581251",
            "telephone_number": "541-298-5158",
            "fax_number": "541-298-3864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN OREGON HEALTHCARE VALLEY VISTA, 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": "1668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "801055",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Dalles Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John D Elliott, M.D.
• Kristina Ann Ensbury
• Elaine Enwards
• Sierra Leeann Estrada
• Bailey Everett
• Daniel Burke Eyer
• Taylor Junior Faaiu
• James C Faherty, M.D.
• Brittany Ella Fallon, NP-C
• Erin Farmer, DNP, FNP

• Skilled Nursing Facility in The Dalles, OR
• Providers in The Dalles, 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.