=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285664037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRANDE RONDE HOSPITAL, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 909 ADAMS AVE
-----------------------------------------------------
City | LA GRANDE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97850-2570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-963-2273
-----------------------------------------------------
Fax | 541-963-1872
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3290
-----------------------------------------------------
City | LA GRANDE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97850-7290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-963-1967
-----------------------------------------------------
Fax | 541-963-1837
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | JEREMY P DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 541-963-1454
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 395287
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------