Provider Demographics
NPI:1780796649
Name:CASCADE COMPREHENSIVE CARE, INC
Entity type:Organization
Organization Name:CASCADE COMPREHENSIVE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IONA
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-883-2947
Mailing Address - Street 1:2909 DAGGETT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-7101
Mailing Address - Country:US
Mailing Address - Phone:541-883-2947
Mailing Address - Fax:541-885-9858
Practice Address - Street 1:2909 DAGGETT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-7101
Practice Address - Country:US
Practice Address - Phone:541-883-2947
Practice Address - Fax:541-885-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07-00000225305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR135843Medicaid