Provider Demographics
NPI:1336147388
Name:CASCADE VISTA CONVALESCENT CENTER, INC.
Entity Type:Organization
Organization Name:CASCADE VISTA CONVALESCENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-885-4157
Mailing Address - Street 1:7950 WILLOWS RD NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6813
Mailing Address - Country:US
Mailing Address - Phone:425-885-4157
Mailing Address - Fax:425-882-3308
Practice Address - Street 1:7950 WILLOWS RD NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6813
Practice Address - Country:US
Practice Address - Phone:425-885-4157
Practice Address - Fax:425-882-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH954314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4195400Medicaid
WA4195400Medicaid