Healthcare Provider Details

I. General information

NPI: 1346598299
Provider Name (Legal Business Name): CARE CENTER (LEWISTON) INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 BURRELL AVE
LEWISTON ID
83501-5589
US

IV. Provider business mailing address

7700 NE PARKWAY DR SUITE 300
VANCOUVER WA
98662-6654
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-4558
  • Fax:
Mailing address:
  • Phone: 360-735-7155
  • Fax: 360-735-9416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: GREGORY J VISLOCKY
Title or Position: EX VP OF FINANCE / PARTNER
Credential:
Phone: 360-816-8295