Healthcare Provider Details

I. General information

NPI: 1780062711
Provider Name (Legal Business Name): TOTALCARE THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20845 GREENMONT DR
BEND OR
97702-2857
US

IV. Provider business mailing address

20845 GREENMONT DR
BEND OR
97702-2857
US

V. Phone/Fax

Practice location:
  • Phone: 541-604-6086
  • Fax:
Mailing address:
  • Phone: 541-604-6086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1106622-93
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1932586070
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerNPI # FOR COMPANY HOSPICE DIVISION

VIII. Authorized Official

Name: CHRISTOPHER GROSSMAN
Title or Position: OWNER
Credential: P.T.
Phone: 541-604-6086