Provider Demographics
NPI:1952990566
Name:SOUTHERN OREGON FRIENDS OF HOSPICE
Entity type:Organization
Organization Name:SOUTHERN OREGON FRIENDS OF HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-500-8911
Mailing Address - Street 1:217 S MODOC AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7782
Mailing Address - Country:US
Mailing Address - Phone:541-941-5960
Mailing Address - Fax:
Practice Address - Street 1:217 S MODOC AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7782
Practice Address - Country:US
Practice Address - Phone:541-941-5960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR165396Medicaid
OR527496Medicaid