Provider Demographics
NPI:1710296793
Name:EVERGREEN OREGON HEALTHCARE ORCHARDS RETIREMENT, L.L.C.
Entity Type:Organization
Organization Name:EVERGREEN OREGON HEALTHCARE ORCHARDS RETIREMENT, L.L.C.
Other - Org Name:CASCADE VALLEY ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-892-6628
Mailing Address - Street 1:4601 NE 77TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6729
Mailing Address - Country:US
Mailing Address - Phone:360-892-6628
Mailing Address - Fax:360-882-5793
Practice Address - Street 1:1010 NE 3RD AVE
Practice Address - Street 2:
Practice Address - City:MILTON FREEWATER
Practice Address - State:OR
Practice Address - Zip Code:97862-9404
Practice Address - Country:US
Practice Address - Phone:541-938-5693
Practice Address - Fax:541-938-4490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVERGREEN OREGON HEALTHCARE, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-24
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1883778809310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR564166Medicaid