Provider Demographics
NPI:1710598420
Name:ESTRELLA OF CASCADIA LLC
Entity Type:Organization
Organization Name:ESTRELLA OF CASCADIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-9600
Mailing Address - Street 1:2205 E RIVERSIDE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7621
Mailing Address - Country:US
Mailing Address - Phone:208-401-9600
Mailing Address - Fax:
Practice Address - Street 1:2020 N 95TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4334
Practice Address - Country:US
Practice Address - Phone:206-351-4535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASCADIA ARIZONA OPERATIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-14
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Single Specialty