Provider Demographics
NPI:1306318274
Name:EMPRES AT CASPER, LLC
Entity type:Organization
Organization Name:EMPRES AT CASPER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO AND ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-892-6628
Mailing Address - Street 1:4601 NE 77TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6736
Mailing Address - Country:US
Mailing Address - Phone:360-892-6628
Mailing Address - Fax:360-882-5793
Practice Address - Street 1:60 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-4035
Practice Address - Country:US
Practice Address - Phone:307-234-9381
Practice Address - Fax:307-472-3510
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPRES WYOMING HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-17
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY15306OtherNURSING FACILITY LICENSE