NPIMap

Organization Active NPI

Providence Health & Services Oregon

  • Home Health Agency
  • Mount Angel, OR
National Provider Identifier
1831196302
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PROVIDENCE HEALTH & SERVICES OREGON
Practice address
570 S Main Street
Mount Angel, OR 97362-9540
Phone
(503) 845-9226
NPI assigned
Jun 30, 2005
Last updated
May 16, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICES OREGONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 16, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X OR Primary

Addresses

Primary practice location

570 S Main Street
Mount Angel, OR 97362-9540

Mailing address

PO Box 2724
Portland, OR 97208-2724
Phone (503) 215-4601

Other identifiers 1

IdentifierTypeStateIssuer
276701MedicaidOR

Other names 1

  • Providence Benedictine Home Health Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030812000046 OR Part A Provider - Home Health Agency 2365353992 Practice locations: Mount Angel, OR; Salem, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831196302. Details of each certification follow.

Home health agency certification: CCN 387074

Legal name
PROVIDENCE HEALTH & SERVICES OREGON
Doing business as
PROVIDENCE BENEDICTINE HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 15, 1984
Last certification
Mar 15, 2018
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Feb 20, 1934 in OR
Enrollment address
570 S Main St
Mount Angel, OR 97362-9540

Care Compare: Home health agency

Medicare Care Compare
Listed as
Providence Benedictine Home HealthCCN 387074 · All quality measures
Overall star rating
4 of 5
Ownership
Non-Profit
Certified
Mar 15, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Part of
Providence Health Services-Oregon

Ownership & related parties

All disclosed owners & managing parties 27

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

NameRoleSinceShare
Diane L Hejna Individual Corporate DirectorBoard of Directors Jul 1, 2016
Richard S Blair Individual Corporate DirectorBoard of Directors Jul 1, 2016
Providence Health & Services-Oregon Organization, Renton, WA Non-profit 5% Or Greater Direct Ownership Interest May 20, 2010
Operational/Managerial Control May 20, 2010
Marvin O'Quinn Individual Corporate DirectorBoard Member Jan 1, 2024
Linda Buck Individual Corporate DirectorBoard Member Jan 1, 2025
Terri P Warren Individual W-2 Managing EmployeeVP/Chief Community Services Nov 1, 2022
Providence Health & Services - Washington Organization, Renton, WA Operational/Managerial Control May 20, 2010
Erik Wexler Individual Corporate OfficerPresident Jan 1, 2023
Mary E Lyons Individual Corporate DirectorBoard of Directors Jul 1, 2016
Nicole Sikes Individual W-2 Managing EmployeeDirector of Biling Aug 20, 2022
Phyllis M Hughes Individual Corporate Director Jan 1, 2014
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
James Martin Individual Corporate OfficerPresident Jan 13, 2023
Malisa J Westlund Individual W-2 Managing EmployeeCfo, Home and Community Care Mar 6, 2020
Charles Wallace Sorenson Individual Corporate DirectorBoard of Directors Jan 1, 2019
Michael D Robinson Individual W-2 Managing EmployeeChief Home Health Feb 3, 2020
Donald Wayne Anderson Individual Corporate OfficerAsst Sec of Enrollment/Dir Reimb Ad Jan 1, 2017
Gregory David Hoffman Individual Corporate OfficerPresident Oct 1, 2020
Isiaah D Crawford Individual Corporate DirectorBoard Member Jan 1, 2012
Donna Markham Individual Corporate DirectorBoard Member Jan 1, 2024
Michael W Murphy Individual Corporate DirectorBoard Member Jan 1, 2020
Providence Health & Services Organization, Renton, WA Non-profit Operational/Managerial Control Jul 1, 2016
Mary Beth Kingston Individual Corporate DirectorBoard Member Sep 1, 2022
Eric D Sprunk Individual Corporate DirectorBoard Member Jan 1, 2022
Anna R Newsom Individual Corporate OfficerCorporate Secretary May 13, 2022
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025
Providence St. Joseph Health Organization, Renton, WA Non-profit Operational/Managerial Control Jul 1, 2016

Facilities with the same owner 141

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 141

Practitioners & affiliated clinicians

Affiliated clinicians 17

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1831196302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2724",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972082724",
            "telephone_number": "503-215-4601",
            "fax_number": "503-215-4624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 S MAIN STREET",
            "city": "MOUNT ANGEL",
            "state": "OR",
            "postal_code": "973629540",
            "telephone_number": "503-845-9226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES OREGON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES OREGON",
        "enumeration_date": "2005-06-30",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "276701",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Benedictine Home Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mount Angel, OR

Sources for this page

Verify at the official NPI Registry.