Healthcare Provider Details

I. General information

NPI: 1093717340
Provider Name (Legal Business Name): MT HOOD HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39085 PIONEER BLVD STE 1018
SANDY OR
97055-8081
US

IV. Provider business mailing address

PO BOX 1269 39641 SCENIC ST.
SANDY OR
97055-1269
US

V. Phone/Fax

Practice location:
  • Phone: 503-668-5545
  • Fax: 503-668-7951
Mailing address:
  • Phone: 503-668-5545
  • Fax: 503-668-7951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number1983-001
License Number StateOR

VIII. Authorized Official

Name: RHONDA CHRISTINE FRANKE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 503-668-5545