Provider Demographics
NPI:1013459965
Name:EMPRES AT THERMOPOLIS, LLC
Entity type:Organization
Organization Name:EMPRES AT THERMOPOLIS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO AND MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIL
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 1:1210 CANYON HILLS RD
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-3137
Practice Address - Country:US
Practice Address - Phone:360-892-6628
Practice Address - Fax:360-882-5793
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPRES WYOMING HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-09
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY145629600Medicaid
WY15229OtherSTATE OF WYOMING. NURSING CARE FACILITY LICENSE
WY145629600Medicaid