Healthcare Provider Details

I. General information

NPI: 1285664037
Provider Name (Legal Business Name): GRANDE RONDE HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 ADAMS AVE
LA GRANDE OR
97850-2570
US

IV. Provider business mailing address

PO BOX 3290
LA GRANDE OR
97850-7290
US

V. Phone/Fax

Practice location:
  • Phone: 541-963-2273
  • Fax: 541-963-1872
Mailing address:
  • Phone: 541-963-1967
  • Fax: 541-963-1837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number395287
License Number StateOR

VIII. Authorized Official

Name: JEREMY P DAVIS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 541-963-1454