EVERGREEN WASHINGTON HEALTHCARE CENTRALIA, L.L.C. (NPI# 1942295993) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942295993 |
| Entity Type | Organization |
| Organization Name | EVERGREEN WASHINGTON HEALTHCARE CENTRALIA, L.L.C. |
| Other Organization Name | EVERGREEN CENTRALIA HEALTH AND REHABILITATION CENTER |
| Practice Address |
1015 Long Rd Centralia WA 98531-1038 |
| Mailing Address |
4601 Ne 77th Ave Suite 300 Vancouver WA 98662-6729 |
| Practice Telephone | 3607363381 |
| Practice Fax Number | 3603302901 |
| Mailing Telephone | 3608926628 |
| Mailing Fax Number | 3608825793 |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2008-07-03 |
| Authorized Official Name | DALE L. PATTERSON (MANAGER) |
| Authorized Official Telephone | 3608926628 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 1224 | WA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 4112249 | 05 |
| Other Name | Type Code |
|---|---|
| Evergreen Centralia Health and Rehabilitation Center | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | EVERGREEN WASHINGTON HEALTHCARE CENTRALIA, L.L.C. | 4601 Ne 77th Ave Ste 300, Vancouver, WA 98662 |
| Street Address |
1015 LONG RD |
| City | CENTRALIA |
| State | WA |
| Zip Code | 98531-1038 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306462205 | Jelisa Renae Thomas | Counselor | 3510 Steelhammer Ln, Centralia, WA 98531 | 2020-06-17 |
| 1205498607 | Jennifer Kristine Mcglynn Paterno | Counselor | 2428 W. Reynods Ave, Centralia, WA 98531 | 2019-07-05 |
| 1538646328 | Adam Jeffrey Moore | Counselor | 3510 Steelhammer Lane, Centralia, WA 98531 | 2018-07-24 |
| 1144706698 | Euijeong Kim | Occupational Therapist | Rehabilitation Therapies, 914 S. Scheuber Rd, Centralia, WA 98531 | 2018-07-18 |
| 1104315266 | Margaret Fowler Floyd | Registered Nurse | Centralia High School, 813 Eshom Road, Centralia, WA 98531 | 2018-05-04 |
| 1124545777 | Samantha Michelle Moody | Speech-Language Pathologist | Centralia School District, 2320 Borst Ave, Centralia, WA 98531 | 2017-08-24 |
| 1821520289 | Alexa Franks | Behavior Technician | 2428 West Reynolds Ave., Centralia, WA 98531 | 2017-04-03 |
| 1023559861 | Brandy Michelle Peterson | Counselor | 135 W. Main Steet, Centralia, WA 98531 | 2017-03-13 |
| 1841738812 | Graceful Healing Naturopathic | Naturopath | 219 N Tower Ave, Suite 304, Centralia, WA 98531 | 2017-02-09 |
| 1043681513 | Angela Naillon | Counselor | 2428 West Reynolds, Centralia, WA 98531 | 2015-10-09 |
| Find all providers in zip 98531 | ||||
| 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 |
|---|---|---|---|---|
| 1568748317 | Friendship-ltc, LLC | Skilled Nursing Facility | 1000 Martin Luther King Dr, Centralia, IL 62801-3002 | 2011-10-25 |
| 1962435941 | Ltc Illinois - Friendship, Inc. | Skilled Nursing Facility | 1000 Martin Luther King, Centralia, IL 62801 | 2006-07-10 |
| 1700819778 | Ltc of Illinois - Fireside, Inc. | Skilled Nursing Facility | 1030 Martin Luther King Dr, Centralia, IL 62801-3002 | 2006-07-10 |
| 1194763565 | Sharon Care Center, Inc | Skilled Nursing Facility | 1509 Harrison Ave, Centralia, WA 98531-4568 | 2006-06-04 |
| 1245227131 | Northwest Country Place, Inc | Skilled Nursing Facility | 917 S Scheuber Rd, Centralia, WA 98531-9027 | 2005-10-05 |
| 1689660961 | Unlimited Development Inc. | Skilled Nursing Facility | 1910 E Mccord, Centralia, IL 62801-6586 | 2005-09-22 |
| 1154328953 | Health Services Administration, Inc | Skilled Nursing Facility | 750 E Highway 22, Centralia, MO 65240-1146 | 2005-07-07 |
| 1861977019 | Hcc-healthcare Properties, LLC | Skilled Nursing Facility | 1030 Martin Luther King Dr, Centralia, IL 62801-3002 | 2018-10-03 |
| 1134632961 | Riverside Nursing - Centralia LLC | Skilled Nursing Facility | 1305 Alexander St, Centralia, WA 98531-1305 | 2017-11-15 |
| 1912305202 | Fmg Alexander Street Washington LLC | Skilled Nursing Facility | 1305 Alexander St, Centralia, WA 98531-1305 | 2014-12-18 |
| Find all providers in CENTRALIA | ||||
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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.