Evergreen Washington Healthcare Centralia, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1224 Issued in WA

Legal business name

EVERGREEN WASHINGTON HEALTHCARE CENTRALIA, L.L.C.

Practice address

1015 Long Rd
Centralia, WA 98531-1038

Phone

(360) 736-3381

Fax

(360) 330-2901

NPI assigned

Sep 15, 2005

Organization subpart

No

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

• Evergreen Centralia Health and Rehabilitation Center Doing business as

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215043200000",
    "number": "1942295993",
    "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": "1015 LONG RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985311038",
            "telephone_number": "360-736-3381",
            "fax_number": "360-330-2901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN WASHINGTON HEALTHCARE CENTRALIA, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-15",
        "last_updated": "2008-07-03",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "1224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4112249",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Centralia Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cary Robert Erickson, M.A.
• Brent Garrett Erwin
• Rylee Marie Erwin
• Stephen William Escott
• Evelyn S Estrada, MD
• F. Andrew Lasley, IV, DMD, PLLC
• Kara Fabiani, LPN
• Dan Fagerness
• John Paul Marcel Fairhart, DPT
• Zahra Azita Fallahi, RN

• Skilled Nursing Facility in Centralia, WA
• Providers in Centralia, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; 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.