Evergreen Oregon Healthcare Independence, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1663 Issued in OR

Legal business name

EVERGREEN OREGON HEALTHCARE INDEPENDENCE, L.L.C.

Doing business as

Independence Health and Rehabilitation Center

Practice address

1525 Monmouth St
Independence, OR 97351-1007

Phone

(503) 838-0001

Fax

(503) 838-7826

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 names 1

• Independence 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": "1497703201",
    "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": "1525 MONMOUTH ST",
            "city": "INDEPENDENCE",
            "state": "OR",
            "postal_code": "973511007",
            "telephone_number": "503-838-0001",
            "fax_number": "503-838-7826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN OREGON HEALTHCARE INDEPENDENCE, 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": "1663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Independence Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Julianne Klingberg Deforest, BA, LMT, CIMT
• Mark Jeffrey Diaz, D.C.
• Doula by Angela
• Helen Dusschee
• Evan L Evans, PHD
• Elizabeth Ra Fertig, OTR/L
• Monica Gabaldon, LCSW
• Brandon Markeith Guidry, LMT#29563
• Gypsum Medical Associates of Oregon, PC
• Christen Marie Hammond, R.N.

• Skilled Nursing Facility in Independence, OR
• Providers in Independence, 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.