EXTENDICARE HOMES, INC. (NPI# 1114091733) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114091733 |
| Entity Type | Organization |
| Organization Name | EXTENDICARE HOMES, INC. |
| Other Organization Name | PACIFIC SPECIALTY AND REHABILITATIVE CARE |
| Practice Address |
1015 N Garrison Rd Vancouver WA 98664-1313 |
| Mailing Address |
111 W Michigan St Milwaukee WI 53203-2903 |
| Practice Telephone | 3606947501 |
| Practice Fax Number | 3606948148 |
| Mailing Telephone | 4149088119 |
| Mailing Fax Number | 4149087105 |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2008-04-07 |
| Authorized Official Name | DONNA JO MAASSEN (DIRECTOR OF COMPLIANCE) |
| Authorized Official Telephone | 4149088119 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 4110094 | 05 |
| Other Name | Type Code |
|---|---|
| Pacific Specialty and Rehabilitative Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740345800 | Extendicare Homes, Inc. | Assisted Living Facility | 100 E Dalke Ave, Spokane, WA 99208-1006 | 2006-12-27 |
| 1639245558 | Extendicare Homes, Inc. | Skilled Nursing Facility | 1902 Mead Ave, Sheboygan, WI 53081-6140 | 2006-11-24 |
| 1912070624 | Extendicare Homes, Inc. | Skilled Nursing Facility | 414 Robey St, Franklin, KY 42134-1034 | 2006-11-17 |
| 1043383771 | Extendicare Homes, Inc. | Skilled Nursing Facility | 2500 N Elm St, Henderson, KY 42420-2005 | 2006-11-17 |
| 1790859486 | Extendicare Homes, Inc. | Skilled Nursing Facility | 3431 N 13th St, Sheboygan, WI 53083-2938 | 2006-11-17 |
| 1871666560 | Extendicare Homes, Inc. | Skilled Nursing Facility | 1561 Newton Ave, Bowling Green, KY 42104-3238 | 2006-11-17 |
| 1215001862 | Extendicare Homes, Inc. | Skilled Nursing Facility | 619 W Walnut St, Milwaukee, WI 53212-3839 | 2006-11-17 |
| 1619041340 | Extendicare Homes, Inc. | Skilled Nursing Facility | 867 Mcguire Ave, Paducah, KY 42001-4036 | 2006-11-17 |
| 1255405700 | Extendicare Homes, Inc. | Skilled Nursing Facility | 2582 Cerulean Rd, Cadiz, KY 42211-9605 | 2006-11-17 |
| 1376617837 | Extendicare Homes, Inc. | Skilled Nursing Facility | 420 E Grundy Ave, Springfield, KY 40069-1173 | 2006-11-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Indiana Business Entities | EXTENDICARE HOMES, INC. | 3500 Lenox Road Ne, Suite 510, Atlanta, GA 30326 |
| Washington State Corporations | EXTENDICARE HOMES, INC. | 3500 Lenox Rd Ne, Suite 510, Atlanta, GA 30326-4229 |
| Street Address |
1015 N GARRISON RD |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98664-1313 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1083002141 | Fmg North Garrison Road Washington LLC | Skilled Nursing Facility | 1015 N Garrison Rd, Vancouver, WA 98664-1354 | 2014-12-24 |
| 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 |
| Find all providers in the same location | ||||
| 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 |
| 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 |
| 1083002141 | Fmg North Garrison Road Washington LLC | Skilled Nursing Facility | 1015 N Garrison Rd, Vancouver, WA 98664-1354 | 2014-12-24 |
| 1194120816 | Vancouver Operations, LLC | Skilled Nursing Facility | 801 Se Park Crest Ave, Vancouver, WA 98683-1300 | 2014-10-23 |
| Find all providers in VANCOUVER | ||||
Please comment or provide details below to improve the information on EXTENDICARE HOMES, INC..
| 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.