Provider Demographics
NPI:1629173588
Name:SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC
Entity Type:Organization
Organization Name:SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC
Other - Org Name:SAINT ALPHONSUS HOME CARE, ONTARIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LANNIE
Authorized Official - Last Name:CHECKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-367-7347
Mailing Address - Street 1:351 SW 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2639
Mailing Address - Country:US
Mailing Address - Phone:541-881-7000
Mailing Address - Fax:541-881-7184
Practice Address - Street 1:824 SW 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2639
Practice Address - Country:US
Practice Address - Phone:541-881-7430
Practice Address - Fax:541-881-7181
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT ALPHONSUS MEDICAL CENTER ONTARIO, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-14
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13140026251E00000X
251E00000X
OR13-1398251E00000X
IDHH-136251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500619294Medicaid
ID808630400Medicaid
OR387120Medicare Oscar/Certification