MEDICARE: EMERALD CARE

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	NH1366	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851386122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD CARE

Provider Business Mailing Address
First Line	:	209 N AHTANUM AVE
Second Line	:
City	:	WAPATO
State	:	WA
Zip	:	98951-1125
Country	:	US
Telephone Number	:	509-877-3175
Fax Number	:	509-877-6135

Provider Business Practice Location Address
First Line	:	209 N AHTANUM AVE
Second Line	:
City	:	WAPATO
State	:	WA
Zip	:	98951-1125
Country	:	US
Telephone Number	:	509-877-3175
Fax Number	:	509-877-6135

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MICHAEL HOON
Credential	:
Telephone Number	:	509-877-3175

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	01/06/2012

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Directions to “EMERALD CARE ” Practice Location

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