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General NPI Number Information
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NPI Number | 1053695262
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Entity Type | Organization
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Legal Business Name | CASCADE PARK CARE CENTER/LIFE CARE CENTERS OF AMERICA
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Dates
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Enumeration Date | 10/06/2011
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 801 SE PARK CREST AVE
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City | VANCOUVER
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State | WA
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Zip | 98683-1300
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Country | US
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Telephone | 360-260-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 808 NW 22ND AVE
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City | BATTLE GROUND
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State | WA
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Zip | 98604-4699
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Country | US
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Telephone | 360-989-8802
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. CARLA REGINA BACH
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Credential | OTR/L, CAPS
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Telephone | 360-989-8802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | OT00004130
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License Number State | WA
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