Provider Demographics
NPI:1003822487
Name:LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Entity Type:Organization
Organization Name:LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Other - Org Name:LEGACY EMANUEL HOSPITAL ADULT PSYCHIATRIC UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-415-5600
Mailing Address - Street 1:PO BOX 4037
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4037
Mailing Address - Country:US
Mailing Address - Phone:503-413-4048
Mailing Address - Fax:503-413-4449
Practice Address - Street 1:1225 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2003
Practice Address - Country:US
Practice Address - Phone:503-944-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-31
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14-0056273R00000X
281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No281P00000XHospitalsChronic Disease Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1000075Medicaid
OR500708766Medicaid
ORR0000ZBBVKMedicare PIN
OR135207Medicaid
WA3350907Medicaid
OR138000700OtherREGENCE BLUE CROSS
OR500700374Medicaid
CAXHSP30596Medicaid
ID3339000Medicaid
AKHS85IPMedicaid
ORR0000ZBBVKMedicare PIN