Provider Demographics
NPI:1316129232
Name:LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Entity type:Organization
Organization Name:LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-415-5145
Mailing Address - Street 1:PO BOX 4399
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4399
Mailing Address - Country:US
Mailing Address - Phone:503-413-3900
Mailing Address - Fax:503-413-3710
Practice Address - Street 1:500 N COLUMBIA RIVER HWY STE 6
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1201
Practice Address - Country:US
Practice Address - Phone:503-397-0471
Practice Address - Fax:503-413-3212
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-03
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213294Medicaid
OR213294Medicaid
OR383867Medicare Oscar/Certification