FMG NORTH GARRISON ROAD WASHINGTON LLC (NPI# 1083002141) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083002141 |
| Entity Type | Organization |
| Organization Name | FMG NORTH GARRISON ROAD WASHINGTON LLC |
| Other Organization Name | PACIFIC SPECIALTY AND REHABILITATIVE CARE |
| Practice Address |
1015 N Garrison Rd Vancouver WA 98664-1354 |
| Practice Telephone | 3606947501 |
| Practice Fax Number | 3606948148 |
| Mailing Telephone | 3606947501 |
| Mailing Fax Number | 3606948148 |
| Enumeration Date | 2014-12-24 |
| Last Update Date | 2014-12-29 |
| Authorized Official Name | DAVID KEATING (AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 4149088058 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Pacific Specialty and Rehabilitative Care | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | FMG NORTH GARRISON ROAD WASHINGTON LLC | 330 East Kilbourn Avenue, Two Plaza East Suite 1085, Milwaukee, WI 53202 |
| Street Address |
1015 N GARRISON RD |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98664-1354 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114091733 | Extendicare Homes, Inc. | Skilled Nursing Facility | 1015 N Garrison Rd, Vancouver, WA 98664-1313 | 2006-11-17 |
| 1811493364 | 1015 North Garrison, LLC | Skilled Nursing Facility | 1015 N Garrison Rd, Vancouver, WA 98664-1313 | 2018-04-03 |
| 1578917324 | Bethany Biel | Occupational Therapist | 1015 N Garrison Rd, Vancouver, WA 98664-1354 | 2016-04-19 |
| 1144689498 | Laura J Lemons | Physical Therapy Assistant | 1015 N Garrison Rd, Vancouver, WA 98664-1354 | 2016-02-15 |
| 1184052151 | Linda Damon | Physical Therapist | 1015 N Garrison Rd, Vancouver, WA 98664-1354 | 2013-10-29 |
| 1770830002 | Sarah Anne Henderson | Speech-Language Pathologist | 1015 N Garrison Rd, Vancouver, WA 98664-1313 | 2012-08-06 |
| 1134389661 | Kimberly Renee O'brien | Occupational Therapist | 1015 N Garrison Rd, Vancouver, WA 98664-1313 | 2008-06-09 |
| 1740451988 | Tina M Berrios | Registered Nurse | 1015 N Garrison Rd, Vancouver, WA 98664-1313 | 2008-03-16 |
| 1780876102 | Wendy R Busch | Occupational Therapist | 1015 N Garrison Rd, Vancouver, WA 98664-1313 | 2007-08-10 |
| 1477744175 | Katherine Ann Donovan | Physical Therapist | 1015 N Garrison Rd, Vancouver, WA 98664-1313 | 2007-08-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285249938 | Angelica Maria Parle-fresquez | Speech-Language Pathologist | Early Childhood Assessment Center - Lieser School, 301 S. Lieser Rd, Vancouver, WA 98664 | 2020-09-10 |
| 1467923441 | Elizabeth Steen | Counselor | 230 E. State St., Mossyrock, WA 98664 | 2018-12-17 |
| 1497241657 | Chelsey Nicole Parker | Peer Specialist | 9815 Ne 3rd St, Vancouver, WA 98664 | 2018-07-10 |
| 1881145431 | Brent Homan | Occupational Therapist | 807 Se Morgan Rd., Vancouver, WA 98664 | 2016-10-19 |
| 1114474277 | Rebecca Marie Stefan | Nurse's Aide | 10025 Ne 19th St, Vancouver, WA 98664 | 2016-09-07 |
| 1528454105 | Alicia Ford | Dietitian, Registered | 700 Ne 87th Ave Ste 280, Vancouver, WA 98664 | 2015-04-10 |
| 1033504261 | Reid Roberts Bennett | Anesthesiology | 505 Ne 87th Ave Ste 210, Vancouver, WA 98664 | 2015-04-03 |
| 1235550856 | Nikolay Nikolaevich Chernukhin Jr. | Chiropractor | 221-a Ne 104th Ave, Suite 205, Vancouver, WA 98664 | 2013-12-27 |
| 1013278712 | Serena Harker | Physical Therapy Assistant | 221a Ne 104th Ave, Suite #205, Vancouver, WA 98664 | 2012-05-30 |
| 1295091080 | Rebeca C Johnson | Massage Therapist | 11015 Ne 4th Plain Suite B, Vancouver, WA 98664 | 2012-04-05 |
| Find all providers in zip 98664 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215455365 | Thirty Three Oaks, LLC | Skilled Nursing Facility | 400 E. 33rd St., Vancouver, WA 98663 | 2017-09-08 |
| 1114091733 | Extendicare Homes, Inc. | Skilled Nursing Facility | 1015 N Garrison Rd, Vancouver, WA 98664-1313 | 2006-11-17 |
| 1336247584 | Fort Vancouver Convalescent Center LLC | Skilled Nursing Facility | 8507 Ne 8th Way, Vancouver, WA 98664-1980 | 2006-09-20 |
| 1629099817 | Kindred Nursing Centers West, LLC | Skilled Nursing Facility | 400 E 33rd St, Vancouver, WA 98663-2238 | 2006-07-22 |
| 1578559894 | Care Center Hazel Dell Inc | Skilled Nursing Facility | 5220 Ne Hazel Dell Ave, Vancouver, WA 98663-1242 | 2005-09-22 |
| 1811493364 | 1015 North Garrison, LLC | Skilled Nursing Facility | 1015 N Garrison Rd, Vancouver, WA 98664-1313 | 2018-04-03 |
| 1396101580 | Puget Sound Senior Psychology LLC | Skilled Nursing Facility | 9340 Ne 76th St, Vancouver, WA 98662-3721 | 2016-01-05 |
| 1144602251 | Melanie Christensen | Skilled Nursing Facility | 801 Se Park Crest Ave, Vancouver, WA 98683-1300 | 2015-06-25 |
| 1568858090 | Fort Vancouver Post Acute, LLC | Skilled Nursing Facility | 8507 Ne 8th Way, Vancouver, WA 98664-1980 | 2015-04-10 |
| 1194120816 | Vancouver Operations, LLC | Skilled Nursing Facility | 801 Se Park Crest Ave, Vancouver, WA 98683-1300 | 2014-10-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.