Provider Demographics
NPI:1861521312
Name:BLUE MOUNTAIN HOSPITAL DISTRICT
Entity type:Organization
Organization Name:BLUE MOUNTAIN HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-575-4151
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97869-0305
Mailing Address - Country:US
Mailing Address - Phone:541-820-3341
Mailing Address - Fax:541-820-3628
Practice Address - Street 1:112 E 5TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE CITY
Practice Address - State:OR
Practice Address - Zip Code:97869
Practice Address - Country:US
Practice Address - Phone:541-820-3341
Practice Address - Fax:541-820-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1367820202313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR801639Medicaid