EVERGREEN AT POLSON, L.L.C. (NPI# 1093763419) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093763419 |
| Entity Type | Organization |
| Organization Name | EVERGREEN AT POLSON, L.L.C. |
| Other Organization Name | POLSON HEALTH AND REHABILITATION CENTER |
| Practice Address |
9 14th Ave W Polson MT 59860-5321 |
| Mailing Address |
4601 Ne 77th Ave Suite 300 Vancouver WA 98662-6736 |
| Practice Telephone | 4068834378 |
| Practice Fax Number | 4068833388 |
| Mailing Telephone | 3608926628 |
| Mailing Fax Number | 3608825793 |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2017-06-13 |
| Authorized Official Name | BRENT WEIL (CEO AND MANAGER) |
| Authorized Official Telephone | 3608926628 |
| Is Organization Subpart | Y |
| Parent Organization Name | EMPRES MONTANA HEALTHCARE, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QH0700X |
Clinic/Center Specialization: Hearing and Speech |
3111 | MT | Ambulatory Health Care Facilities |
| N | 261QH0700X |
Clinic/Center Specialization: Hearing and Speech |
3582 | MT | Ambulatory Health Care Facilities |
| Y | 314000000X | Skilled Nursing Facility | 10145 | MT | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MT | 310622 | 05 |
| Other Name | Type Code |
|---|---|
| Polson Health and Rehabilitation Center | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | EVERGREEN AT POLSON, L.L.C. | 9 14th Ave W, Polson, MT 59860-5321 |
| Street Address |
9 14TH AVE W |
| City | POLSON |
| State | MT |
| Zip Code | 59860-5321 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104463264 | Alyssa Jacqueline Bovy | Occupational Therapy Assistant | 9 14th Ave W, Polson, MT 59860-5321 | 2019-12-06 |
| 1902358419 | Katherine Lansing | Physical Therapy Assistant | 9 14th Ave W, Polson, MT 59860-5321 | 2016-11-01 |
| 1225317324 | Carol Francom | Physical Therapy Assistant | 9 14th Ave W, Polson, MT 59860-5321 | 2011-08-08 |
| 1821264706 | Tania Stevens | Occupational Therapist | 9 14th Ave W, Polson, MT 59860-5321 | 2008-05-01 |
| 1992971881 | Amanda Lorene Bender | Physical Therapy Assistant | 9 14th Ave W, Polson, MT 59860-5321 | 2008-05-01 |
| 1891969762 | Cynthia A Difrancesco | Physical Therapist | 9 14th Ave W, Polson, MT 59860-5321 | 2008-04-22 |
| 1821110206 | Julie A Burke | Speech-Language Pathologist | 9 14th Ave W, Polson, MT 59860-5321 | 2007-04-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679095020 | Ashley J Gilham | Registered Nurse | #5 4th Ave E., Polson, MT 59860 | 2017-07-07 |
| 1225585532 | St. Luke Community Hospital | Clinic/Center | 107 Ridgewater Dr., Polson, MT 59860 | 2016-09-02 |
| 1306202163 | Western Montana Mental Health Center | Community Based Residential Treatment Facility, Mental Illness | 7 13th Ave East, Polson, MT 59860 | 2016-01-11 |
| 1154730364 | Wanda L King | Dietitian, Registered | 6 Thirteenth Avenue East, Poslon, MT 59860 | 2014-08-13 |
| 1104255637 | Dacia Lee Antiste-fisher | Counselor | #5 4th Ave. E., Polson, MT 59860 | 2013-11-05 |
| 1154758134 | Richard Pierre | Pharmacy Technician | 5 4th Ave E., Polson, MT 59860 | 2013-10-04 |
| 1154755197 | Wal-mart Stores, Inc | Durable Medical Equipment & Medical Supplies | 36318 Memory Lane, Polson, MT 59860 | 2013-08-27 |
| 1245582022 | Catherine D Addison | Registered Nurse | 5 4th Ave. East, Polson, MT 59860 | 2012-10-04 |
| 1114220787 | Erika Ann Weber | Social Worker | #5 4th Ave. E, Polson, MT 59860 | 2010-12-21 |
| 1942431473 | Lisa L. Scalpane | Counselor | 803 Main Street, Suite C, Polson, MT 59860 | 2009-07-31 |
| Find all providers in zip 59860 | ||||
| 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. |
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|---|---|---|---|---|
| 1770047581 | Lakeview Assisted Living LLC | Skilled Nursing Facility | 7437 Castle Rock Lake Dr, Colstrip, MT 59323-9533 | 2019-01-25 |
| 1124426283 | Genesis Rehabilitation | Skilled Nursing Facility | 1130 17 Th Ave South, Great Falls, MT 59405 | 2014-12-05 |
| 1336546811 | Empres At Lewistown, LLC | Skilled Nursing Facility | 410 Wendell Ave, Lewistown, MT 59457-2261 | 2014-11-26 |
| 1053728014 | Montana Vamc | Skilled Nursing Facility | 210 South Winchester, Miles City, MT 59301-4757 | 2014-07-22 |
| 1912189572 | Northeast Montana Health Services,inc | Skilled Nursing Facility | 1000 6th Ave N, Wolf Point, MT 59201-1828 | 2007-12-05 |
| 1205051729 | Elkhorn Health Care Inc | Skilled Nursing Facility | 474 Mt Highway 282, Clancy, MT 59634-9519 | 2007-04-17 |
| 1508990698 | Chouteau County District Hospital | Skilled Nursing Facility | 1501 St. Charles, Fort Benton, MT 59442 | 2007-03-14 |
| 1386790160 | Cnh Acquisitions Inc. | Skilled Nursing Facility | 3131 Amherst Ave, Butte, MT 59701-4653 | 2007-01-26 |
| 1942378534 | Memorial Hospital Association | Skilled Nursing Facility | 600 West 21st St, Red Lodge, MT 59068-0590 | 2006-12-01 |
| 1538248067 | Blackfeet Tribe | Skilled Nursing Facility | South Government Square, South Government Square, Browning, MT 59417-0728 | 2006-11-03 |
| Find all providers with the same taxonomy | ||||
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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.