Evergreen Washington Healthcare Manor, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1226 Issued in WA

Legal business name

EVERGREEN WASHINGTON HEALTHCARE MANOR, L.L.C.

Practice address

1330 11TH Ave
Longview, WA 98632-3817

Phone

(360) 425-6706

Fax

(360) 423-3002

NPI assigned

May 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dale L. Patterson

Title

Manager

Phone

(360) 892-6628

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Evergreen Manor Health and Rehabilitation Center Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica K Smith

  • Registered Nurse
  • Longview, WA
  • NPI 1699732354
  NPD (past)

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215388800000",
    "number": "1619925328",
    "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": "986626729",
            "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": "1330 11TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323817",
            "telephone_number": "360-425-6706",
            "fax_number": "360-423-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN WASHINGTON HEALTHCARE MANOR, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2008-07-07",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "360-892-6628",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "1226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4112264",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Manor Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Evergreen Americana Health and Rehabilitation Center
• Evergreen at Park Royal II, L.L.C.
• Evergreen Prosthetics and Orthotics, LLC
• Evergreen Washington Healthcare Americana, L.L.C.
• Evergreen Washington Healthcare Frontier, L.L.C.
• Brandon Excell
• Kelly Anne Exner, M.A.
• John Leigh Ey, M.D.
• Eyemart Express LLC
• Amanda Fairbanks

• Skilled Nursing Facility in Longview, WA
• Providers in Longview, 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 Jul 7, 2008; 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.