Provider Demographics
NPI:1629403894
Name:ROGUE VALLEY IN HOME CARE INC.
Entity Type:Organization
Organization Name:ROGUE VALLEY IN HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:PERRINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-245-0963
Mailing Address - Street 1:712 CRATER LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6525
Mailing Address - Country:US
Mailing Address - Phone:541-245-0963
Mailing Address - Fax:541-772-0656
Practice Address - Street 1:712 CRATER LAKE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6525
Practice Address - Country:US
Practice Address - Phone:541-245-0963
Practice Address - Fax:541-772-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2148251E00000X
OR15.2148253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500662775Medicaid
OR524575Medicaid