NPIMap

Organization Active NPI

Shaw Mountain of Cascadia, LLC

Doing business as Shaw Mountain of Cascadia

  • Skilled Nursing Facility
  • Boise, ID
National Provider Identifier
1700245594
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SHAW MOUNTAIN OF CASCADIA, LLC
Doing business as
Shaw Mountain of Cascadia
Practice address
909 E Reserve St
Boise, ID 83712-6508
Phone
(208) 343-7717
Fax
(208) 692-9909
NPI assigned
Feb 22, 2016
Last updated
Jan 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Authorized official

Name
Owen Hammond
Title
President
Phone
(208) 401-9600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

909 E Reserve St
Boise, ID 83712-6508

Mailing address

909 E Reserve St
Boise, ID 83712-6508
Phone (208) 343-7717

Other names 1

  • Shaw Mountain of Cascadia Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160322001040 ID Part A Provider - Skilled Nursing Facility 5193022978 Practice locations: Boise, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700245594. Details of each certification follow.

Skilled nursing facility certification: CCN 135090

Legal name
SHAW MOUNTAIN OF CASCADIA LLC
Doing business as
SHAW MOUNTAIN OF CASCADIA
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 1, 1981
Last certification
Mar 7, 2025
Beds
108
Ownership / control type
Corporation
Multi-facility organization
Cascadia Healthcare
Organization structure
LLCProprietary
Incorporated
Jun 30, 2015 in DE
Enrollment address
909 E Reserve St
Boise, ID 83712-6508
Nursing home name
SHAW MOUNTAIN OF CASCADIA
Affiliated entity
CASCADIA HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Shaw Mountain of CascadiaCCN 135090 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Sep 1, 1981
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10890.9 residents per day on average
Chain
Cascadia Healthcare46 facilities in the chain
Penalties (3 years)
1Fines totaling $10,839

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D0522014Shaw Mountain of Cascadia909 Reserve St, Boise, ID 83712Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Ability Network2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Cascadia Services LLC Organization, Eagle, ID LLC Operational/Managerial Control Jun 30, 2015
Adp of the SNF Feb 12, 2025
Cascadia HC Group LLC Organization, Eagle, ID LLC, Owned by another organization or individual Indirect Ownership Interest Jun 5, 2025 100%
Cascadia Healthcare LLC Organization, Eagle, ID LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 30, 2015
Indirect Ownership Interest May 1, 2016 100%
Stephen J Laforte Individual Operational/Managerial Control Jun 5, 2025
Indirect Ownership Interest Jun 5, 2025 33.33%
Braden Bair Individual Operational/Managerial Control Jun 1, 2025
Adp of the SNF Jun 23, 2025
Owen C Hammond Individual Operational/Managerial Control May 1, 2016
Indirect Ownership Interest May 1, 2016 33.34%
White Oak Healthcare Finance LLC Organization, New York, NY LLC, Financial institution, Owned by another organization or individual 5% Or Greater Security Interest Aug 11, 2022 100%
Ryan J Williams Individual Operational/Managerial Control Dec 5, 2016
Adp of the SNF Feb 12, 2025
Cascadia Holdco LLC Organization, Eagle, ID LLC, Owned by another organization or individual Indirect Ownership Interest Jun 5, 2025 100%
Cascadia Idaho Operations LLC Organization, Eagle, ID LLC, Owned by another organization or individual Direct Ownership Interest May 1, 2016 100%
Timothy Nelson Individual Operational/Managerial Control Jun 5, 2025
Indirect Ownership Interest Jun 5, 2025 33.33%
Timberline Ctre Tenant LLC Organization, New York, NY LLC, Owned by another organization or individual 5% Or Greater Security Interest Jun 5, 2025 100%
Adp of the SNF Jun 5, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 45

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 45

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1456099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1700245594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 E RESERVE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126508",
            "telephone_number": "208-343-7717",
            "fax_number": "208-692-9909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 E RESERVE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126508",
            "telephone_number": "208-343-7717",
            "fax_number": "208-692-9909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAW MOUNTAIN OF CASCADIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-22",
        "last_updated": "2024-01-23",
        "certification_date": "2022-08-19",
        "status": "A",
        "authorized_official_last_name": "HAMMOND",
        "authorized_official_first_name": "OWEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-401-9600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Shaw Mountain of Cascadia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shaw Mountain of Cascadia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.