NPIMap

Organization Active NPI

Columbia River Health

  • Federally Qualified Health Center (FQHC)
  • Boardman, OR
National Provider Identifier
1710084140
Registry record updated Jun 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COLUMBIA RIVER HEALTH
Practice address
450 Tatone St
Boardman, OR 97818-8076
Phone
(541) 481-7212
Fax
(541) 481-2020
NPI assigned
Sep 20, 2006
Last updated
Jun 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sanjuanita Olivas, CPC, CPPM
Title
Revenue Cycle Director
Phone
(541) 481-5448

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

450 Tatone St
Boardman, OR 97818-8076

Mailing address

PO Box 397
Boardman, OR 97818-0397
Phone (541) 481-7212

Other identifiers 1

IdentifierTypeStateIssuer
276286MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041230000039 OR Part A Provider - Federally Qualified Health Center (FQHC) 8527026087 Practice locations: Boardman, OR
O20051010000108 OR Part B Supplier - Clinic/Group Practice 8527026087 Receives reassigned benefits from 6 practitioners
Practice locations: Boardman, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710084140. Details of each certification follow.

Federally qualified health center certification: CCN 381885

Legal name
COLUMBIA RIVER HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 7, 2005
Last certification
Mar 7, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 22, 2004 in OR
Enrollment address
450 Tatone St
Boardman, OR 97818-8076

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D1036868Columbia River Health450 Tatone St, Boardman, OR 97818Provider-performed microscopyJul 31, 2027

National Provider Directory

National Provider Directory

Locations

450 Tatone St
Boardman, OR 97818
Phone (541) 481-7212

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Michael Hughes Individual Corporate OfficerBoard Chair Mar 1, 2021
Tess Rehak Individual Corporate OfficerBoard Member Jan 8, 2025
Stan Chaffin Individual Corporate OfficerBoard Secretary Nov 1, 2019
Mario Sepulveda Individual Corporate OfficerBoard Member Jan 8, 2025
Elvia Ayala Individual Corporate OfficerBoard Member Mar 1, 2021
Sheila Marie Corpus Individual Corporate DirectorCeo Jan 1, 2025
Amber Savage Individual Corporate OfficerBoard Vice Chair May 1, 2022
Yves a Lefranc Individual W-2 Managing EmployeeMD; Nov 19, 2021
Natalie Melendez Individual Corporate OfficerBoard Member May 1, 2022
Jason Hendricks Individual Corporate OfficerBoard Treasurer May 1, 2022
Sanjuanita Olivas Individual W-2 Managing EmployeeRevenue Cycle Director Aug 19, 2019
Maryann Hancock Individual Corporate OfficerBoard Member May 1, 2022

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781049600000",
    "number": "1710084140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 397",
            "city": "BOARDMAN",
            "state": "OR",
            "postal_code": "978180397",
            "telephone_number": "541-481-7212",
            "fax_number": "541-481-5447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 TATONE ST",
            "city": "BOARDMAN",
            "state": "OR",
            "postal_code": "978188076",
            "telephone_number": "541-481-7212",
            "fax_number": "541-481-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA RIVER HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A",
        "authorized_official_last_name": "OLIVAS",
        "authorized_official_first_name": "SANJUANITA",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "541-481-5448",
        "authorized_official_credential": "CPC, CPPM"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "276286",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OR

Sources for this page

Verify at the official NPI Registry.