Provider Demographics
NPI:1124181987
Name:WASCO COUNTY NURSING CARE INC
Entity Type:Organization
Organization Name:WASCO COUNTY NURSING CARE INC
Other - Org Name:COLUMBIA BASIN CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-296-2000
Mailing Address - Street 1:1015 WEBBER
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3586
Mailing Address - Country:US
Mailing Address - Phone:541-296-2156
Mailing Address - Fax:541-298-1528
Practice Address - Street 1:1015 WEBBER
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3586
Practice Address - Country:US
Practice Address - Phone:541-296-2156
Practice Address - Fax:541-298-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR385049314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR801092Medicaid
WA4580163Medicaid
WA4580163Medicaid