Healthcare Provider Details

I. General information

NPI: 1629173588
Provider Name (Legal Business Name): SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 SW 4TH AVENUE
ONTARIO OR
97914-2639
US

IV. Provider business mailing address

351 SW 9TH STREET
ONTARIO OR
97914-2639
US

V. Phone/Fax

Practice location:
  • Phone: 541-881-7430
  • Fax: 541-881-7181
Mailing address:
  • Phone: 541-881-7000
  • Fax: 541-881-7184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number13140026
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHH-136
License Number StateID
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number13-1398
License Number StateOR

VIII. Authorized Official

Name: BRIAN LANNIE CHECKETTS
Title or Position: CFO
Credential:
Phone: 208-367-7347