EVERGREEN AT MISSOULA, L.L.C. (NPI# 1538117940) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538117940 |
| 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 98662-6736 |
| Practice Telephone | 4065490988 |
| Practice Fax Number | 4065490111 |
| Mailing Telephone | 3608926628 |
| Mailing Fax Number | 3608825793 |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2017-01-30 |
| 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 | 225X00000X | Occupational Therapist | MT | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | |
| N | 310400000X | Assisted Living Facility | MT | Nursing & Custodial Care Facilities | |
| N | 314000000X | Skilled Nursing Facility | 7280 | MT | Nursing & Custodial Care Facilities |
| Y | 314000000X | Skilled Nursing Facility | MT | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MT | 0310029 | 05 |
| Other Name | Type Code |
|---|---|
| Missoula Health and Rehabilitation Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447703533 | Evergreen At Missoula, L.L.C. | Skilled Nursing Facility | 3018 Rattlesnake Dr, Missoula, MT 59802-6101 | 2016-07-26 |
| Street Address |
3018 RATTLESNAKE DR |
| City | MISSOULA |
| State | MT |
| Zip Code | 59802-6101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1285164442 | Barry Arthur Olson | Physical Therapist | 3018 Rattlesnake Dr, Missoula, MT 59802-6101 | 2017-06-19 |
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| 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 |
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| 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 |
|---|---|---|---|---|
| 1043276058 | Hillside Health Care Center, LLC | Skilled Nursing Facility | 4720 23rd Ave, Missoula, MT 59803-1137 | 2006-04-26 |
| 1811954662 | Community Nursing Inc. | Skilled Nursing Facility | 2651 South Ave W, Missoula, MT 59804-6405 | 2006-04-26 |
| 1356308399 | Riverside Health Care Center | Skilled Nursing Facility | 1301 E Broadway St, Missoula, MT 59802-4905 | 2006-04-26 |
| 1447703533 | Evergreen At Missoula, L.L.C. | Skilled Nursing Facility | 3018 Rattlesnake Dr, Missoula, MT 59802-6101 | 2016-07-26 |
| 1770815276 | Providence Health & Services Mt | Skilled Nursing Facility | 500 W Broadway St, Missoula, MT 59802-4096 | 2010-02-08 |
| 1740373877 | Saint Patrick Hospital Corporation | Skilled Nursing Facility | 500 W Broadway St, Missoula, MT 59802-4008 | 2006-10-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
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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.