Healthcare Provider Details

I. General information

NPI: 1144215542
Provider Name (Legal Business Name): ST. CHARLES HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 NE DOCTORS DR STE 7
BEND OR
97701-6324
US

IV. Provider business mailing address

PO BOX 6095
BEND OR
97708-6095
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-7796
  • Fax: 541-706-4996
Mailing address:
  • Phone: 541-382-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number14-1457
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier4700002
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerCLEAR CHOICE
# 2
Identifier292836
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 3
Identifier400072
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerCOIHS
# 4
Identifier239482000001
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerPROVIDENCE HEALTH PLAN
# 5
Identifier081408000
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerBLUE CROSS OF OREGON
# 6
IdentifierP328701
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerPACIFICSOURCE HEALTH PLAN

VIII. Authorized Official

Name: MATTHEW R SWAFFORD
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 541-382-4321