Provider Demographics
NPI:1467881706
Name:CENTERSOURCE CORPORATION
Entity Type:Organization
Organization Name:CENTERSOURCE CORPORATION
Other - Org Name:VECTOR REMOTE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-293-1472
Mailing Address - Street 1:2988 NW FAIRWAY HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-8334
Mailing Address - Country:US
Mailing Address - Phone:877-293-1472
Mailing Address - Fax:877-293-1475
Practice Address - Street 1:2988 NW FAIRWAY HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-8334
Practice Address - Country:US
Practice Address - Phone:877-293-1472
Practice Address - Fax:877-293-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory