Provider Demographics
NPI:1114947942
Name:COLUMBIA LUTHERAN CHARITIES
Entity Type:Organization
Organization Name:COLUMBIA LUTHERAN CHARITIES
Other - Org Name:COLUMBIA MEMORIAL HOSPITAL HOME HEALTH SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:O
Authorized Official - Last Name:FINKLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA, CHE
Authorized Official - Phone:503-325-4321
Mailing Address - Street 1:2111 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3329
Mailing Address - Country:US
Mailing Address - Phone:503-325-4321
Mailing Address - Fax:
Practice Address - Street 1:486 12TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4122
Practice Address - Country:US
Practice Address - Phone:503-338-6230
Practice Address - Fax:503-338-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR141146251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR05795800OtherBLUE CROSS
OR129218Medicaid
OR129218Medicaid