Provider Demographics
NPI:1326589771
Name:SAINT MOSCATI COMMUNITY HEALTH CARE
Entity Type:Organization
Organization Name:SAINT MOSCATI COMMUNITY HEALTH CARE
Other - Org Name:SAINT MOSCATI COMMUNITY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-273-0679
Mailing Address - Street 1:1880 LANCASTER DR NE STE 104
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1040
Mailing Address - Country:US
Mailing Address - Phone:971-273-0679
Mailing Address - Fax:503-961-0794
Practice Address - Street 1:1880 LANCASTER DR NE STE 104
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1040
Practice Address - Country:US
Practice Address - Phone:971-273-0679
Practice Address - Fax:503-961-0794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-18
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201600993NP-PP261Q00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500746269Medicaid