Provider Demographics
NPI:1073594065
Name:PEACEHEALTH
Entity Type:Organization
Organization Name:PEACEHEALTH
Other - Org Name:SACRED HEART HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYS VP FIN INTEGRIT/CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-729-1132
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 328
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8003
Mailing Address - Country:US
Mailing Address - Phone:360-729-1462
Mailing Address - Fax:360-729-3104
Practice Address - Street 1:123 INTERNATIONAL WAY OFC B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1047
Practice Address - Country:US
Practice Address - Phone:458-205-7400
Practice Address - Fax:458-205-7459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16-1053251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR132113Medicaid
OR381529Medicare Oscar/Certification