Organization
PROVIDENCE HEALTH SYSTEMS
Active
Other names
PACE Program
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY DAIGLE (RN CM)
(503) 513-1300
Entity
Organization
Contact information
Practice address
10330 SE 32ND AVE STE 110, MILWAUKIE, OR 97222-6596
(503) 717-3013
Mailing address
10330 SE 32ND AVE STE 110, MILWAUKIE, OR 97222-6596
(503) 717-3013
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
931146501
—
OR
Enumeration date
11/22/2021
Last updated
11/22/2021
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