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DSH380007U LEGACY EMANUEL HOSPITAL & HEALTH CENTER (Active)
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Main Details
Name
LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Subdivision Name
Legacy Emanuel Cardiac Rehabilitation / Cardiac Rehab 150-3440
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380007U
Medicare Provider Number
380007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/11/2019
Participating Start Date
10/1/2019
Participating Approval Date
8/8/2019
Last Recertification Date
9/2/2024
Contacts
Authorizing Official
Legacy Health
Kecia Kelly, SVP Chief Nursing Officer
(503) 415-5199
Primary Contact
Legacy Health
Elena Valcarlos, Pharmacy Systems Manager
(503) 413-7764
Addresses
Street Address
501 N Graham St
100
Portland, OR 97227
Billing Address
LEGACY EMANUEL HOSPITAL & HEALTH CTR
2801 N Gantenbein Ave
Portland, OR 97227
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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