Provider Demographics
NPI:1962844241
Name:PROVIDENCE HEALTH & SERVICES-OREGON
Entity Type:Organization
Organization Name:PROVIDENCE HEALTH & SERVICES-OREGON
Other - Org Name:PROVIDENCE BENEDICTINE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR REIMB REG STRAT/ASST SEC ENROLL
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:425-525-5392
Mailing Address - Street 1:PO BOX 2724
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2724
Mailing Address - Country:US
Mailing Address - Phone:503-215-4601
Mailing Address - Fax:503-215-4624
Practice Address - Street 1:580 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT ANGEL
Practice Address - State:OR
Practice Address - Zip Code:97362-9540
Practice Address - Country:US
Practice Address - Phone:503-845-2463
Practice Address - Fax:503-845-2716
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE HEALTH & SERVICES-OREGON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-26
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
381562Medicare Oscar/Certification