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DSH380007X LEGACY EMANUEL HOSPITAL & HEALTH CENTER (Active)
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Main Details
Name
LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Subdivision Name
UBH PES Center for Behavioral Health Emergency Department - Psychiatric Emergency Services 170-3280
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380007X
Medicare Provider Number
380007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/16/2023
Participating Start Date
10/1/2023
Participating Approval Date
9/6/2023
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
1225 NE 2nd Ave
Portland, OR 97232
Billing Address
Legacy Emanuel Hospital & Health Center
2801 N Gantenbein Ave
Portland, OR 97227
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (01/1/2021) until terminated effective date: (04/1/2021); reinstatement effective date: (10/1/2023)
08/11/2023
April 2025
April 2025
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