Provider Demographics
NPI:1306476395
Name:NDCARE LLC
Entity type:Organization
Organization Name:NDCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CELISHA
Authorized Official - Middle Name:RUNNE
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:407-257-3557
Mailing Address - Street 1:PO BOX 1421
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0106
Mailing Address - Country:US
Mailing Address - Phone:541-773-8111
Mailing Address - Fax:541-773-9501
Practice Address - Street 1:836 E MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7115
Practice Address - Country:US
Practice Address - Phone:541-773-8111
Practice Address - Fax:541-773-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500731820Medicaid