Provider Demographics
NPI:1144215542
Name:ST. CHARLES HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:ST. CHARLES HEALTH SYSTEM, INC.
Other - Org Name:ST. CHARLES HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:SWAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-382-4321
Mailing Address - Street 1:PO BOX 6095
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6095
Mailing Address - Country:US
Mailing Address - Phone:541-382-4321
Mailing Address - Fax:
Practice Address - Street 1:2275 NE DOCTORS DR STE 7
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6324
Practice Address - Country:US
Practice Address - Phone:541-706-7796
Practice Address - Fax:541-706-4996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14-1457251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR4700002OtherCLEAR CHOICE
OR292836Medicaid
OR400072OtherCOIHS
OR239482000001OtherPROVIDENCE HEALTH PLAN
OR081408000OtherBLUE CROSS OF OREGON
ORP328701OtherPACIFICSOURCE HEALTH PLAN
ORP328701OtherPACIFICSOURCE HEALTH PLAN