Evergreen Idaho Healthcare Sandpoint, L.L.C.
Organization Active NPI Assisted Living Facility · Sandpoint, ID
NPI 1891003554 · NPPES record last updated Jun 2, 2011
Key facts
- NPI
- 1891003554
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- RC-511 (ID)
- Legal business name
- EVERGREEN IDAHO HEALTHCARE SANDPOINT, L.L.C.
- Practice address
- 624 S Division Ave
Sandpoint, ID 83864-1749 - Phone
- (208) 265-2354
- Fax
- (208) 263-8787
- NPI assigned
- Sep 15, 2010
- Organization subpart
- Yes
- Parent organization (as reported)
- EVERGREEN IDAHO HEALTHCARE, L.L.C.
Authorized official
- Name
- Dale L Patterson
- Title
- Manager
- Phone
- (360) 892-6628
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | RC-511 | ID | Yes |
Addresses
Primary practice location
624 S Division Ave
Sandpoint, ID 83864-1749
Mailing address
4601 NE 77TH Ave
Suite 300
Vancouver, WA 98662-6729
Phone (360) 892-6628
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8055822 | Medicaid | ID |
Other names
- Sandoint Assisted Living Facility
Other providers in Sandpoint, ID
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- Angela K Evans
- Linda Evans
- Evebreastfeeding, PLLC
- Meredith Rae Evensen-Lynch
- Eye Care for You
- Eye Clinic of Sandpoint PA
- Eye Clinic of Sandpoint PA
- Patricia Ann Factor
- John McLain Faggard III
All providers in Sandpoint, ID · Assisted Living Facility in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.