Evergreen Oregon Healthcare Mountain Vista,L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1664 Issued in OR

Legal business name

EVERGREEN OREGON HEALTHCARE MOUNTAIN VISTA,L.L.C.

Practice address

91 Aries LN
La Grande, OR 97850-3309

Phone

(541) 963-8678

Fax

(541) 963-5024

NPI assigned

May 4, 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

• LaGrande Post Acute Rehab 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": "1801844501",
    "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": "91 ARIES LN",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978503309",
            "telephone_number": "541-963-8678",
            "fax_number": "541-963-5024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN OREGON HEALTHCARE MOUNTAIN VISTA,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": "1664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "801035",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LaGrande Post Acute Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tracy Ann Epperson, MD
• Dorian Dirraitong Eriich
• Kory Escobar
• PJ Etnol
• Chelsie Evans, RN
• Evergreen Oregon Healthcare Vallley View, L.L.C.
• Esmina I Evstropova
• F Thacher Carter PSYD PC
• Micki J Fabian, M.ED
• Haylee Farrar, DPT

• Skilled Nursing Facility in La Grande, OR
• Providers in La Grande, 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.