Provider Demographics
NPI:1477064780
Name:LEWISTON OF CASCADIA, LLC
Entity Type:Organization
Organization Name:LEWISTON OF CASCADIA, LLC
Other - Org Name:LEWISTON TRANSITIONAL CARE OF CASCADIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LAFORTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-351-4535
Mailing Address - Street 1:408 S EAGLE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6079
Mailing Address - Country:US
Mailing Address - Phone:208-401-9600
Mailing Address - Fax:
Practice Address - Street 1:3315 8TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4966
Practice Address - Country:US
Practice Address - Phone:208-743-9543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility