EVERGREEN WASHINGTON HEALTHCARE AUBURN, L.L.C. (NPI# 1235187931) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235187931 |
| Entity Type | Organization |
| Organization Name | EVERGREEN WASHINGTON HEALTHCARE AUBURN, L.L.C. |
| Other Organization Name | CANTERBURY HOUSE |
| Practice Address |
502 29th St Se Auburn WA 98002-7532 |
| Mailing Address |
4601 Ne 77th Ave Suite 300 Vancouver WA 98662-6736 |
| Practice Telephone | 2539390090 |
| Practice Fax Number | 2539390095 |
| Mailing Telephone | 3608926628 |
| Mailing Fax Number | 3608825793 |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2017-01-30 |
| Authorized Official Name | BRENT WEIL (CEO AND MANAGER) |
| Authorized Official Telephone | 3608926628 |
| Is Organization Subpart | Y |
| Parent Organization Name | EMPRES WASHINGTON HEALTHCARE, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 1269 | WA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 4112694 | 05 |
| Other Name | Type Code |
|---|---|
| Canterbury House | Doing Business As Name - Organization |
| Street Address |
502 29TH ST SE |
| City | AUBURN |
| State | WA |
| Zip Code | 98002-7532 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164043485 | Shaked Hamer | Physical Therapist | 502 29th St Se, Auburn, WA 98002-7532 | 2020-04-27 |
| 1780158055 | Faith Michelle Syders | Physical Therapy Assistant | 502 29th St Se, Auburn, WA 98002-7532 | 2019-01-19 |
| 1942710462 | Angela Pederzani | Speech-Language Pathologist | 502 29th St Se, Auburn, WA 98002-7532 | 2017-10-11 |
| 1487171310 | Jodi O'neil | Occupational Therapy Assistant | 502 29th St Se, Auburn, WA 98002-7532 | 2017-08-22 |
| 1043740921 | Quincy Marie Mortimer | Occupational Therapist | 502 29th St Se, Auburn, WA 98002-7532 | 2017-06-14 |
| 1952660789 | Jana Wakasugi | Physical Therapist | 502 29th St Se, Auburn, WA 98002-7532 | 2012-05-14 |
| 1386962728 | Shannon Elizabeth Shaw | Occupational Therapy Assistant | 502 29th St Se, Auburn, WA 98002-7532 | 2010-05-10 |
| 1538323092 | Amy Johnson | Occupational Therapist | 502 29th St Se, Auburn, WA 98002-7532 | 2008-07-14 |
| 1407010309 | Donna L Jungbluth | Physical Therapy Assistant | 502 29th St Se, Auburn, WA 98002-7532 | 2008-07-10 |
| 1285898189 | Justin Michael Lanphear | Physical Therapy Assistant | 502 29th St Se, Auburn, WA 98002-7532 | 2008-07-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336756451 | Natalia Marquez Avalos | Interpreter | 1001 37th St Se, Apt 2, Auburn, WA 98002 | 2020-09-24 |
| 1871065607 | Carrie Ann Sasser | Registered Nurse | 1005 37th Street Se, Auburn, WA 98002 | 2018-12-18 |
| 1730658881 | Nataliya Guga | Physical Therapy Assistant | 1323 17th St Se Apt A, Auburn, WA 98002 | 2018-11-19 |
| 1952876294 | Modeline Jules | Nurse Practitioner | 125 3rd St Ne Ste 403, Auburn, WA 98002 | 2018-10-12 |
| 1679055941 | Stephanie Storm Lariccia | Social Worker | 1000 Auburn Way S., Auburn, WA 98002 | 2018-09-04 |
| 1104330349 | North Auburn Health, LLC | Skilled Nursing Facility | 2830 I Street Ne, Auburn, WA 98002 | 2017-11-27 |
| 1265950554 | Allison Ortwein | Occupational Therapist | 2830 I St. Ne, Auburn, WA 98002 | 2017-09-06 |
| 1184171167 | Emily Faber | Counselor | 505 29th St, Auburn, WA 98002 | 2016-09-07 |
| 1255887907 | Elaine Priscilla Lucas | Counselor | 29th St Se Chartley House, 505, Auburn, WA 98002 | 2016-08-31 |
| 1871955823 | Melissa Mae Gustafson | Massage Therapist | 4220 A. St. Se, Suite 103, Auburn, WA 98002 | 2016-03-28 |
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| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104330349 | North Auburn Health, LLC | Skilled Nursing Facility | 2830 I Street Ne, Auburn, WA 98002 | 2017-11-27 |
| 1962869461 | Seattle University | Skilled Nursing Facility | 32049 109th Pl Se, Auburn, WA 98092-2567 | 2016-01-28 |
| 1619307964 | Leota Lynn Gibson | Skilled Nursing Facility | 4642 S 282nd St, Auburn, WA 98001-1110 | 2013-11-23 |
| 1295950475 | Wesley Healthcare Inc. | Skilled Nursing Facility | 1751 Wesley Rd, Auburn, IN 46706-3647 | 2007-04-14 |
| 1811061518 | North Auburn Health LLC | Skilled Nursing Facility | 2830 I St Ne, Auburn, WA 98002-2410 | 2006-11-17 |
| 1104938976 | Madera Convalscent Hospital, Inc. | Skilled Nursing Facility | 260 Racetrack St, Auburn, CA 95603-5422 | 2006-08-31 |
| 1700806585 | Siena Care Center, LLC | Skilled Nursing Facility | 11600 Education St, Auburn, CA 95602-2468 | 2006-07-21 |
| 1508828716 | Auburn Medical Investors, LLC | Skilled Nursing Facility | 14 Masonic Cir, Auburn, MA 01501-1341 | 2006-04-04 |
| 1902889215 | Auburn Community Hospital | Skilled Nursing Facility | 20 Park Ave, Auburn, NY 13021 | 2005-11-22 |
| 1538141379 | The Health and Hospital Corporation of Marion County | Skilled Nursing Facility | 116 Betz Rd, Auburn, IN 46706 | 2005-11-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.