Provider Demographics
NPI:1215301163
Name:CASCADE IN HOME CARE, LLC
Entity type:Organization
Organization Name:CASCADE IN HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MENEFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-633-7436
Mailing Address - Street 1:2195 NE PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6028
Mailing Address - Country:US
Mailing Address - Phone:541-633-7436
Mailing Address - Fax:541-633-7438
Practice Address - Street 1:2195 NE PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6028
Practice Address - Country:US
Practice Address - Phone:541-633-7436
Practice Address - Fax:541-633-7438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2219253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR524564Medicaid