Healthcare Provider Details

I. General information

NPI: 1700809829
Provider Name (Legal Business Name): LEGACY SALMON CREEK HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NE 139TH ST
VANCOUVER WA
98686
US

IV. Provider business mailing address

PO BOX 4037
PORTLAND OR
97208-4037
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-1000
  • Fax:
Mailing address:
  • Phone: 503-413-4048
  • Fax: 503-413-3212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246YR1600X
TaxonomyRegistered Record Administrator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberH208
License Number StateWA

VIII. Authorized Official

Name: SARAH JENSEN
Title or Position: VP FINANCE
Credential:
Phone: 503-415-5145