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.

Practice address

1525 Monmouth St
Independence, OR 97351-1007

Phone

(503) 838-0001

Fax

(503) 838-7826

NPI assigned

May 4, 2006

Organization subpart

Yes

Parent organization

EMPRES OREGON HEALTHCARE, LLCAs reported in NPPES

Name

Brent Weil

Title

Ceo and Manager

Phone

(360) 892-6628

• Independence Health and Rehabilitation Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 30, 2017.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "801030",
            "state": "OR"
        }
    ],
    "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.

• All providers in Independence, OR
• 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.