Provider Demographics
NPI:1497519151
Name:CASCADE PARK SPECIALTY CARE HOME LLC
Entity Type:Organization
Organization Name:CASCADE PARK SPECIALTY CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-913-8129
Mailing Address - Street 1:2308 SE 146TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8444
Mailing Address - Country:US
Mailing Address - Phone:360-558-7244
Mailing Address - Fax:
Practice Address - Street 1:2308 SE 146TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-8444
Practice Address - Country:US
Practice Address - Phone:360-558-7244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty