Provider Demographics
NPI:1700318755
Name:CASCADE MEDICAL CARE,LLC
Entity Type:Organization
Organization Name:CASCADE MEDICAL CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:541-923-3970
Mailing Address - Street 1:1228 NW CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1335
Mailing Address - Country:US
Mailing Address - Phone:541-923-3970
Mailing Address - Fax:541-699-4336
Practice Address - Street 1:2408 NE DIVISION ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3543
Practice Address - Country:US
Practice Address - Phone:541-382-7521
Practice Address - Fax:541-382-6297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550094NP164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty