1093715070 NPI number — WILLAMETTE VALLEY HOSPICE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093715070 NPI number — WILLAMETTE VALLEY HOSPICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLAMETTE VALLEY HOSPICE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WILLAMETTE VALLEY HOSPICE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093715070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 3RD ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97304-4007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-588-3600
Provider Business Mailing Address Fax Number:
503-363-3891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 3RD ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97304-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-588-3600
Provider Business Practice Location Address Fax Number:
503-363-3891
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DETHROW
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
FINANCE MANAGER
Authorized Official Telephone Number:
503-779-2308

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  N/A , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8008493 . This is a "REGENCE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 112347 . This is a "KAISER PERMANENTE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 132212 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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