Organization
EVERGREEN AT CLANCY, L.L.C.
Active
Other names
Evergreen Clancy Health and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW V MARTINI (MANAGER)
(360) 892-6628
Entity
Organization
Contact information
Practice address
474 HIGHWAY 282, CLANCY, MT 59634-9519
(406) 933-8311
(406) 933-8391
Mailing address
4601 NE 77TH AVE, SUITE 300, VANCOUVER, WA 98662-6729
(360) 892-6628
(260) 882-5793
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
9261
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
310012
—
MT
Enumeration date
05/05/2006
Last updated
08/22/2020
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