| Host | |
|
1143 Liberty St Ne Salem OR 97301-1047 | |
| (503) 588-5825 | |
| (503) 364-1027 |
| Full Name | Host |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1143 Liberty St Ne, Salem, Oregon |
| Authorized Official Name and Position | Kimberly Leathley (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5035885828 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Host 681 Center St Ne Salem OR 97301-3722 Ph: (503) 588-5828 | Host 1143 Liberty St Ne Salem OR 97301-1047 Ph: (503) 588-5825 |
| NPI Number | 1164123196 |
|---|---|
| Provider Enumeration Date | 03/16/2023 |
| Last Update Date | 08/18/2026 |
| Certification Date | 08/18/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164123196 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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