1184629339 NPI number — WILLAMETTE FALLS HOSPITAL

Table of content: (NPI 1184629339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184629339 NPI number — WILLAMETTE FALLS HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLAMETTE FALLS HOSPITAL
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:
PROVIDENCE WILLAMETTE FALLS HOSPICE
Provider Other Organization Name Type Code:
3
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:
1184629339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4400 NE HALSEY ST
Provider Second Line Business Mailing Address:
BUILDING 1 SUITE 129
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97213-1545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-215-4741
Provider Business Mailing Address Fax Number:
503-215-4778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREGON CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97045-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-655-7581
Provider Business Practice Location Address Fax Number:
503-655-7585
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
OLSON
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIVISION DIRECTOR-PROV HOME SVCS
Authorized Official Telephone Number:
503-215-4756

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , 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: 275185 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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