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PROVIDENCE HEALTH & SERVICES-OREGON NPI 1376625137


NPI Information

NPI: 1376625137
Provider Name: PROVIDENCE HEALTH & SERVICES-OREGON

Doing Business As: PROVIDENCE CHILD CENTER

Classification: Nursing Facility/Intermediate Care Facility - 313M00000X
Entity Type: Organization
Address:
830 NE 47TH AVE
PORTLAND, OR
ZIP 97213
Phone: (503) 215-2400
Get Directions

PROVIDENCE HEALTH & SERVICES-OREGON is a nursing facility intermediate care facility in Portland, OR. The provider is an institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. PROVIDENCE HEALTH & SERVICES-OREGON NPI is 1376625137. The provider is registered as an organization entity type.
The provider Is Doing Business As Providence Child Center.

The provider's business location address is:

830 NE 47TH AVE
PORTLAND, OR
ZIP 97213-212
Phone: (503) 215-2400
Fax: (503) 215-0660

The provider's authorized official is Donald Wayne Anderson .
The authorized official title is Asst Sec Enrollmt/dir Reimb Reg and has the following contact phone number (425) 525-5392.

The enumeration date for this NPI number is 10/20/2006 and was last updated on 8/28/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
13140N1450XSkilled Nursing FacilityNursing Care, Pediatric1035453259OREGONNo
2385HR2065XRespite CareRespite Care, Physical Disabilities, Child1035453259OREGONNo
3313M00000XNursing Facility/Intermediate Care Facility1700250565OREGONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1807297MEDICAIDOREGON
24570701MEDICAIDWASHINGTON
31035453259OTHEROREGONDEPT OF HUMAN SVCS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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