Organization
PROVIDENCE HEALTH & SERVICE - OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGON
Other names
Providence ElderPlace - Portland
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Authorized official
DONALD WAYNE ANDERSON (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
4400 NE HALSEY ST, BUILDING 1, STE 200, PORTLAND, OR 97213
(503) 215-6556
(503) 215-0685
Mailing address
4400 NE HALSEY ST, BUILDING 1, STE 200, PORTLAND, OR 97213
(503) 215-6556
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005673
—
OR
Enumeration date
08/29/2022
Last updated
05/16/2025
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