# EVERGREEN WASHINGTON HEALTHCARE FRONTIER, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** EMPRES WASHINGTON HEALTHCARE, LLC
- **Other names:** Frontier Rehabilitation and Extended Care Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104811207
- **Legal business name:** EMPRES WASHINGTON HEALTHCARE, LLC
- **Authorized official:** BRENT WEIL (CEO AND MANAGER)
- **Authorized official phone:** (360) 892-6628

## Contact information

- **Practice address:** 1500 3RD AVE, LONGVIEW, WA 98632-8632
- **Practice address phone:** (360) 423-8800
- **Practice address fax:** (360) 636-3421
- **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 |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 1225 | WA | Yes |

## Other

- **Enumeration date:** 09/14/2005
- **Last updated:** 01/30/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1225 | STATE NH\# | WA |
| 05 | — | 4112256 | — | WA |