Provider Demographics
NPI:1093753386
Name:WILLAMETTE COMMUNITY HEALTH SOLUTIONS
Entity Type:Organization
Organization Name:WILLAMETTE COMMUNITY HEALTH SOLUTIONS
Other - Org Name:CASCADE HEALTH SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOYUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-228-3002
Mailing Address - Street 1:2650 SUZANNE WAY, #200
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7619
Mailing Address - Country:US
Mailing Address - Phone:541-228-3008
Mailing Address - Fax:541-228-3180
Practice Address - Street 1:2650 SUZANNE WAY, #200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7619
Practice Address - Country:US
Practice Address - Phone:541-228-3008
Practice Address - Fax:541-228-3180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR131378251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR133129Medicaid
OR381501Medicare PIN