Healthcare Provider Details

I. General information

NPI: 1114947942
Provider Name (Legal Business Name): COLUMBIA LUTHERAN CHARITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 12TH ST
ASTORIA OR
97103-4122
US

IV. Provider business mailing address

2111 EXCHANGE ST
ASTORIA OR
97103-3329
US

V. Phone/Fax

Practice location:
  • Phone: 503-338-6230
  • Fax: 503-338-6240
Mailing address:
  • Phone: 503-325-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number141146
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier05795800
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerBLUE CROSS
# 2
Identifier129218
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MR. TERRY O FINKLEIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RPH, MBA, CHE
Phone: 503-325-4321