Basic Information
| Provider Information | |||||||||
| NPI: | 1053695262 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CASCADE PARK CARE CENTER/LIFE CARE CENTERS OF AMERICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 808 NW 22ND AVE | ||||||||
| Address2: | |||||||||
| City: | BATTLE GROUND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986044699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609898802 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 SE PARK CREST AVE | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986831300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602602200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2011 | ||||||||
| LastUpdateDate: | 10/25/2011 | ||||||||
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| AuthorizedOfficialLastName: | BACH | ||||||||
| AuthorizedOfficialFirstName: | CARLA | ||||||||
| AuthorizedOfficialMiddleName: | REGINA | ||||||||
| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3609898802 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | OTR/L, CAPS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | OT00004130 | WA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.