Provider Demographics
NPI:1295724870
Name:SAMARITAN HEART OF THE VALLEY
Entity type:Organization
Organization Name:SAMARITAN HEART OF THE VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-768-4020
Mailing Address - Street 1:2750 NW HARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5208
Mailing Address - Country:US
Mailing Address - Phone:541-768-4000
Mailing Address - Fax:541-768-4183
Practice Address - Street 1:2750 NW HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5208
Practice Address - Country:US
Practice Address - Phone:541-768-4000
Practice Address - Fax:541-768-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR800005Medicaid
OR385205Medicare Oscar/Certification