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General NPI Number Information
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NPI Number | 1609142595
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Entity Type | Organization
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Legal Business Name | PEACEHEALTH
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 1515 VILLAGE DR
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City | COTTAGE GROVE
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State | OR
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Zip | 97424-9700
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Country | US
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Telephone | 541-686-7034
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Fax | 541-335-2325
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Provider Business Mailing Address
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Address Line | 1515 VILLAGE DR
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City | COTTAGE GROVE
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State | OR
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Zip | 97424-9700
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Country | US
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Telephone | 541-686-7034
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Fax | 541-335-2325
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Authorized Official
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Title or Position | CFO
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Name | MS. WENDY APLAND
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Credential | CPA
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Telephone | 541-686-3858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 40 0223
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License Number State | OR
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