Provider Demographics
NPI:1841284494
Name:EVERGREEN NORTH CASCADES HEALTH & REHAB CTR.
Entity type:Organization
Organization Name:EVERGREEN NORTH CASCADES HEALTH & REHAB CTR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH INFORMATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUNDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-398-1966
Mailing Address - Street 1:4680 CORDATA PKWY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8038
Mailing Address - Country:US
Mailing Address - Phone:360-398-1966
Mailing Address - Fax:360-398-9346
Practice Address - Street 1:4680 CORDATA PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8038
Practice Address - Country:US
Practice Address - Phone:360-398-1966
Practice Address - Fax:360-398-9346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH 1348314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4113023Medicaid
WA505393Medicare ID - Type UnspecifiedFED MEDICARE PROVIDER