Provider Demographics
NPI:1184629339
Name:WILLAMETTE FALLS HOSPITAL
Entity Type:Organization
Organization Name:WILLAMETTE FALLS HOSPITAL
Other - Org Name:PROVIDENCE WILLAMETTE FALLS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISION DIRECTOR-PROV HOME SVCS
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:503-215-4756
Mailing Address - Street 1:4400 NE HALSEY ST
Mailing Address - Street 2:BUILDING 1 SUITE 129
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1545
Mailing Address - Country:US
Mailing Address - Phone:503-215-4741
Mailing Address - Fax:503-215-4778
Practice Address - Street 1:1505 DIVISION ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1526
Practice Address - Country:US
Practice Address - Phone:503-655-7581
Practice Address - Fax:503-655-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275185Medicaid
OR381514Medicare Oscar/Certification