EVERGREEN AT MISSOULA, L.L.C. (NPI# 1447703533) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447703533 |
| Entity Type | Organization |
| Organization Name | EVERGREEN AT MISSOULA, L.L.C. |
| Other Organization Name | MISSOULA HEALTH AND REHABILITATION CENTER |
| Practice Address |
3018 Rattlesnake Dr Missoula MT 59802-6101 |
| Mailing Address |
4601 Ne 77th Ave Suite 300 Vancouver WA 98662-6729 |
| Practice Telephone | 4065490988 |
| Practice Fax Number | 4065490111 |
| Mailing Telephone | 3608926628 |
| Mailing Fax Number | 3608825793 |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2017-02-01 |
| Authorized Official Name | BRENT WEIL (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 | 314000000X | Skilled Nursing Facility | MT | Nursing & Custodial Care Facilities | |
| N | 310400000X | Assisted Living Facility | 13184 | MT | Nursing & Custodial Care Facilities |
| N | 225X00000X | Occupational Therapist | MT | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | |
| Y | 310400000X | Assisted Living Facility | MT | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Missoula Health and Rehabilitation Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538117940 | Evergreen At Missoula, L.L.C. | Occupational Therapist | 3018 Rattlesnake Dr, Missoula, MT 59802-6101 | 2006-05-05 |
| Street Address |
3018 RATTLESNAKE DR |
| City | MISSOULA |
| State | MT |
| Zip Code | 59802-6101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538117940 | Evergreen At Missoula, L.L.C. | Occupational Therapist | 3018 Rattlesnake Dr, Missoula, MT 59802-6101 | 2006-05-05 |
| 1457917395 | Alison Zmud | Physical Therapy Assistant | 3018 Rattlesnake Dr, Missoula, MT 59802-6101 | 2019-05-16 |
| 1588120794 | Lauren Nichole Shreading | Occupational Therapist | 3018 Rattlesnake Dr, Missoula, MT 59802-6101 | 2019-02-12 |
| 1982169132 | Allison Tubbs | Physical Therapy Assistant | 3018 Rattlesnake Dr, Missoula, MT 59802-6101 | 2019-02-01 |
| 1780162834 | Lorraine Thunstrom | Speech-Language Pathologist | 3018 Rattlesnake Dr, Missoula, MT 59802-6101 | 2018-07-31 |
| 1578087854 | Tana Sue Ostrowski | Occupational Therapy Assistant | 3018 Rattlesnake Dr, Missoula, MT 59802-6101 | 2017-07-28 |
| 1306368758 | Alane Kay Dobie | Speech-Language Pathologist | 3018 Rattlesnake Dr, Missoula, MT 59802-6101 | 2017-07-07 |
| 1841711710 | Nancy Lynn Kinsey | Occupational Therapist | 3018 Rattlesnake Dr, Missoula, MT 59802-6101 | 2017-06-30 |
| 1528588100 | Karen Sue Granberry | Physical Therapist | 3018 Rattlesnake Dr, Missoula, MT 59802-6101 | 2017-06-23 |
| 1073033833 | Elizabeth Anne Beringer | Physical Therapist | 3018 Rattlesnake Dr, Missoula, MT 59802-6101 | 2017-06-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945921 | Montana Endoscopy Center, Pllc | Clinic/Center | 1930 W Broadway, Ste B, Missoula, MT 59802 | 2020-06-08 |
| 1194364091 | Tommie Lynn Perusich | Nurse Practitioner | 1120 Cedar St., Missoula, MT 59802 | 2019-12-26 |
| 1386122752 | The Hope Health Alliance, Inc. | Case Management | 314 White House Ln, Missoula, MT 59802 | 2018-07-30 |
| 1881181444 | Carol Anne Lesser | Massage Therapist | 1918 Birch St, Missoula, MT 59802 | 2018-04-19 |
| 1528587581 | Missoula Aids Fund, Inc. | Clinic/Center | 1500 W. Broadway Suite A, Missoula, MT 59802 | 2017-09-11 |
| 1942740667 | Gabrielle Shulman | Counselor | 415 N Higgins Ave Ste 14, Missoula, MT 59802 | 2017-02-28 |
| 1053798736 | Endurance Physio | Clinic/Center | 214 E. Main St, Missoula, MT 59802 | 2015-05-01 |
| 1720481971 | Anna Golding | Counselor | 1325 Wyoming Street, Missoula, MONTANA 59802 | 2014-10-02 |
| 1003255803 | Jennifer Dawn Danielson | Speech-Language Pathologist | 2408 Duncan Drive, Missoula, MT 59802 | 2013-06-14 |
| 1437595725 | Partnership Health Center Inc | Clinic/Center | 1150 Sherwood St, Missoula, MT 59802 | 2013-05-14 |
| Find all providers in zip 59802 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003318759 | Senescence Care, Inc. | Assisted Living Facility | 3000 St Thomas Dr, Missoula, MT 59803-2946 | 2018-03-07 |
| 1629475256 | Grandma's House Inc. | Assisted Living Facility | 2327 39th St, Missoula, MT 59803-1124 | 2014-11-25 |
| 1891057477 | The Heights | Assisted Living Facility | 901 Ben Hogan Dr, Missoula, MT 59803-2402 | 2012-06-11 |
| 1861677171 | Flor Haven Home LLC | Assisted Living Facility | 433 S 3rd St W, Missoula, MT 59801-2519 | 2008-01-04 |
| 1790802593 | Gary Alan Wingfield | Assisted Living Facility | 1300 Speedway Ave, Missoula, MT 59802-5566 | 2007-03-25 |
| 1184749863 | Bonnie Kolden Dba Pleasant View Personal Care Home | Assisted Living Facility | 4322 W Central Ave, Missoula, MT 59804-6216 | 2007-03-20 |
| 1619015898 | Century Village Inc | Assisted Living Facility | 2120 S Reserve St Pmb 117, Missoula, MT 59801-6451 | 2007-02-01 |
| 1366595597 | Edgewood Vista | Assisted Living Facility | 2815 Palmer St, Missoula, MT 59808-1643 | 2007-01-19 |
| 1245268671 | Vsr LLC | Assisted Living Facility | 2815 Old Fort Rd, Missoula, MT 59804-7422 | 2006-06-28 |
| 1609811306 | Hillside Health Care Center, LLC | Assisted Living Facility | 4718 23rd Ave, Suite 300, Missoula, MT 59803-1163 | 2006-06-17 |
| Find all providers in MISSOULA | ||||
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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.