Provider Demographics
NPI:1912450461
Name:ROGUE COMMUNITY HEALTH
Entity Type:Organization
Organization Name:ROGUE COMMUNITY HEALTH
Other - Org Name:TABLE ROCK HEALTH CENTER
Other - Org Type:Doing Business As
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 1:2830 MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-1357
Mailing Address - Country:US
Mailing Address - Phone:541-830-1350
Mailing Address - Fax:541-830-6566
Practice Address - Street 1:2830 MAPLE CT
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-1357
Practice Address - Country:US
Practice Address - Phone:541-830-1350
Practice Address - Fax:541-830-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)