Provider Demographics
NPI:1932103363
Name:GLASRIDGE VENTURES, LLC
Entity Type:Organization
Organization Name:GLASRIDGE VENTURES, LLC
Other - Org Name:BEAR CREEK HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-929-4834
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1359
Mailing Address - Country:US
Mailing Address - Phone:541-929-4834
Mailing Address - Fax:541-929-4836
Practice Address - Street 1:902 APPLEGATE ST
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9439
Practice Address - Country:US
Practice Address - Phone:541-929-4834
Practice Address - Fax:541-929-4836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182484Medicaid
OR4333590001Medicare NSC