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

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Evergreen Manor Health and Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619925328
- **Authorized official:** MR. DALE L. PATTERSON (MANAGER)
- **Authorized official phone:** (360) 892-6628

## Contact information

- **Practice address:** 1330 11TH AVE, LONGVIEW, WA 98632-3817
- **Practice address phone:** (360) 425-6706
- **Practice address fax:** (360) 423-3002
- **Mailing address:** 4601 NE 77TH AVE, SUITE 300, VANCOUVER, WA 98662-6729
- **Mailing address phone:** (360) 892-6628
- **Mailing address fax:** (360) 882-5793

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 1226 | WA | Yes |

## Other

- **Enumeration date:** 05/05/2006
- **Last updated:** 07/07/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4112264 | — | WA |