# EVERGREEN AT POLSON, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** EMPRES MONTANA HEALTHCARE, LLC
- **Other names:** Polson Health and Rehabilitation Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1093763419
- **Legal business name:** EMPRES MONTANA HEALTHCARE, LLC
- **Authorized official:** BRENT WEIL (CEO AND MANAGER)
- **Authorized official phone:** (360) 892-6628

## Contact information

- **Practice address:** 9 14TH AVE W, POLSON, MT 59860-5321
- **Practice address phone:** (406) 883-4378
- **Practice address fax:** (406) 883-3388
- **Mailing address:** 4601 NE 77TH AVE, SUITE 300, VANCOUVER, WA 98662-6736
- **Mailing address phone:** (360) 892-6628
- **Mailing address fax:** (360) 882-5793

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | — | — | — |
| 261QH0700X | Hearing and Speech Clinic/Center | 3111 | MT | — |
| 261QH0700X | Hearing and Speech Clinic/Center | 3582 | MT | — |
| 314000000X | Skilled Nursing Facility | 10145 | MT | Yes |

## Other

- **Enumeration date:** 05/05/2006
- **Last updated:** 03/11/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 310622 | — | MT |