MEDICARE: WOOD VILLAGE OF CASCADIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1497492672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOOD VILLAGE OF CASCADIA, LLC

Provider Business Mailing Address
First Line	:	2205 E RIVERSIDE DR STE 100
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616-7621
Country	:	US
Telephone Number	:	208-781-9164
Fax Number	:

Provider Business Practice Location Address
First Line	:	2060 NE 238TH DR
Second Line	:
City	:	WOOD VILLAGE
State	:	OR
Zip	:	97060-1007
Country	:	US
Telephone Number	:	503-491-0553
Fax Number	:

Authorized Official
Title or Position	:	GENERAL COUNSEL
Name	:	MR. STEVE LAFORTE
Credential	:	ESQ.
Telephone Number	:	206-351-4535

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	05/18/2022

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