Healthcare Provider Details

I. General information

NPI: 1497519151
Provider Name (Legal Business Name): CASCADE PARK SPECIALTY CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 SE 146TH AVE
VANCOUVER WA
98683-8444
US

IV. Provider business mailing address

2308 SE 146TH AVE
VANCOUVER WA
98683-8444
US

V. Phone/Fax

Practice location:
  • Phone: 360-558-7244
  • Fax:
Mailing address:
  • Phone: 360-558-7244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALIN BOB
Title or Position: PRESIDENT
Credential:
Phone: 503-913-8129