Provider Demographics
NPI:1891844718
Name:CASCADE HEALTHCARE COMMUNITY
Entity Type:Organization
Organization Name:CASCADE HEALTHCARE COMMUNITY
Other - Org Name:PIONEER MEMORIAL HOSPITAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXEC OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-447-2501
Mailing Address - Street 1:1201 NE ELM ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1206
Mailing Address - Country:US
Mailing Address - Phone:541-447-6254
Mailing Address - Fax:541-447-2514
Practice Address - Street 1:1201 NE ELM ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1206
Practice Address - Country:US
Practice Address - Phone:541-447-6254
Practice Address - Fax:541-447-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13140239251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR292467Medicaid
OR230916Medicaid
OR053280Medicaid
OR387096Medicare Oscar/Certification