Organization
EVERGREEN IDAHO HEALTHCARE SANDPOINT, L.L.C.
Active
Parent organization
EVERGREEN IDAHO HEALTHCARE, L.L.C.
Other names
Sandoint Assisted Living Facility
Organization subpart
Yes
Provider details
NPI number
Legal business name
EVERGREEN IDAHO HEALTHCARE, L.L.C.
Authorized official
DALE L PATTERSON (MANAGER)
(360) 892-6628
Entity
Organization
Contact information
Practice address
624 S DIVISION AVE, SANDPOINT, ID 83864-1749
(208) 265-2354
(208) 263-8787
Mailing address
4601 NE 77TH AVE, SUITE 300, VANCOUVER, WA 98662-6729
(360) 892-6628
(360) 882-5793
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
RC-511
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8055822
—
ID
Enumeration date
09/15/2010
Last updated
06/02/2011
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