Provider Demographics
NPI:1205998309
Name:ROGUE COMMUNITY HEALTH
Entity type:Organization
Organization Name:ROGUE COMMUNITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CALISA
Authorized Official - Middle Name:N
Authorized Official - Last Name:WARNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-842-7642
Mailing Address - Street 1:99 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1787
Mailing Address - Country:US
Mailing Address - Phone:541-428-9741
Mailing Address - Fax:541-488-6141
Practice Address - Street 1:99 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1787
Practice Address - Country:US
Practice Address - Phone:541-428-9741
Practice Address - Fax:541-488-6141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227698Medicaid
OR227698Medicaid
OR381857Medicare PIN