Evergreen Oregon Healthcare Salem, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1677 Issued in OR

Legal business name

EVERGREEN OREGON HEALTHCARE SALEM, L.L.C.

Practice address

820 Cottage St NE
Salem, OR 97301-2426

Phone

(503) 399-1135

Fax

(503) 399-7273

NPI assigned

May 5, 2006

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

• Windsor Health and Rehabilitation Center Doing business as

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1760430482",
    "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": "820 COTTAGE ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973012426",
            "telephone_number": "503-399-1135",
            "fax_number": "503-399-7273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN OREGON HEALTHCARE SALEM, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMPRES OREGON HEALTHCARE, LLC",
        "enumeration_date": "2006-05-05",
        "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": "1677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "800001",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Windsor Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Halley Evans
• Isabella Evans
• Jessica Evans
• Kristin M Everett, MD
• Evergreen Behavioral Health, LLC
• Aaron Michael Evers, BSN, MS, FNP-C
• Dale William Evola, LMFT
• John Theodore Ewanyk, DC
• Allison Porter Ewer
• Rebecca J Ewing

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