Evergreen Idaho Healthcare Sandpoint, L.L.C.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

RC-511 Issued in ID

Legal business name

EVERGREEN IDAHO HEALTHCARE SANDPOINT, L.L.C.

Doing business as

Sandoint Assisted Living Facility

Practice address

624 S Division Ave
Sandpoint, ID 83864-1749

Phone

(208) 265-2354

Fax

(208) 263-8787

NPI assigned

Sep 15, 2010

Last updated

Jun 2, 2011By the provider in NPPES

Organization subpart

Yes

Parent organization

EVERGREEN IDAHO HEALTHCARE, L.L.C.As reported in NPPES

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

Authorized official

Name

Dale L Patterson

Title

Manager

Phone

(360) 892-6628

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sandoint Assisted Living Facility Doing business as

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

{
    "created_epoch": "1284508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306972800000",
    "number": "1891003554",
    "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": "624 S DIVISION AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641749",
            "telephone_number": "208-265-2354",
            "fax_number": "208-263-8787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN IDAHO HEALTHCARE SANDPOINT, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERGREEN IDAHO HEALTHCARE, L.L.C.",
        "enumeration_date": "2010-09-15",
        "last_updated": "2011-06-02",
        "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"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "ID",
            "license": "RC-511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8055822",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sandoint Assisted Living Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Sandpoint, ID
• Providers in Sandpoint, ID by specialty
• Assisted Living Facility in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2011; 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.