Organization
VILLAGE HEALTHCARE OF LA GRANDE, INC.
Active
Other names
village healthcare of corvallis
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE EDWARDS FNP (MANAGER PROVIDER PRESIDENT)
(541) 552-0386
Entity
Organization
Contact information
Practice address
656 NW MIRADOR PL, CORVALLIS, OR 97330-4698
(541) 624-2040
(503) 200-2258
Mailing address
656 NW MIRADOR PL, CORVALLIS, OR 97330-4698
(541) 552-0386
(503) 200-2258
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
200450130NP
OR
305S00000X
Point of Service
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131713
—
OR
05
—
269505
—
OR
Enumeration date
05/06/2009
Last updated
11/19/2019
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