Provider Demographics
NPI:1851386122
Name:EMERALD CARE
Entity Type:Organization
Organization Name:EMERALD CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-877-3175
Mailing Address - Street 1:209 N AHTANUM AVE
Mailing Address - Street 2:
Mailing Address - City:WAPATO
Mailing Address - State:WA
Mailing Address - Zip Code:98951-1125
Mailing Address - Country:US
Mailing Address - Phone:509-877-3175
Mailing Address - Fax:509-877-6135
Practice Address - Street 1:209 N AHTANUM AVE
Practice Address - Street 2:
Practice Address - City:WAPATO
Practice Address - State:WA
Practice Address - Zip Code:98951-1125
Practice Address - Country:US
Practice Address - Phone:509-877-3175
Practice Address - Fax:509-877-6135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH1366314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0025300Medicaid
WA4113668Medicaid
WA4113668Medicaid