1275576159 NPI number — ALSEA RURAL HEALTH CARE, 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 1275576159 NPI number — ALSEA RURAL HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALSEA RURAL HEALTH CARE, 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:
Provider Other Organization Name Type Code:
6
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:
1275576159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
435 E. ALDER ST.
Provider Second Line Business Mailing Address:
PO BOX 229
Provider Business Mailing Address City Name:
ALSEA
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97324-0229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-487-7116
Provider Business Mailing Address Fax Number:
541-487-4076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N. 4TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALSEA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97324-0229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-487-7116
Provider Business Practice Location Address Fax Number:
541-487-4076
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARR
Authorized Official First Name:
MARY ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
FAMILY NURSE PRACTITIONER
Authorized Official Telephone Number:
541-487-7116

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , 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: 267872 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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