Provider Demographics
NPI:1730386509
Name:HEARTHSTONE
Entity type:Organization
Organization Name:HEARTHSTONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-789-4103
Mailing Address - Street 1:2901 E BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8308
Mailing Address - Country:US
Mailing Address - Phone:541-789-4472
Mailing Address - Fax:
Practice Address - Street 1:2901 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8308
Practice Address - Country:US
Practice Address - Phone:541-789-4472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASANTE HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-27
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK808451Medicaid
OK808451Medicaid