Provider Demographics
NPI:1861491813
Name:PALLIATIVE CARE SERVICES, INC.
Entity Type:Organization
Organization Name:PALLIATIVE CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:FURMAN GRILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-269-2986
Mailing Address - Street 1:1620 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2150
Mailing Address - Country:US
Mailing Address - Phone:541-269-2986
Mailing Address - Fax:541-269-7987
Practice Address - Street 1:1610 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2150
Practice Address - Country:US
Practice Address - Phone:541-269-2986
Practice Address - Fax:541-269-7987
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH COAST HOSPICE & PALLIATIVE CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-20
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 207QH0002X
ORPA01254363A00000X
OR200770015CNS364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR024366Medicaid
OR130455Medicare PIN