Healthcare Provider Details

I. General information

NPI: 1912533506
Provider Name (Legal Business Name): LUCAS HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 SE 3RD ST # 100
BEND OR
97702-9949
US

IV. Provider business mailing address

230 SE 3RD ST # 100
BEND OR
97702-9949
US

V. Phone/Fax

Practice location:
  • Phone: 541-639-4400
  • Fax:
Mailing address:
  • Phone: 541-639-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier500776832
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier500856430
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MR. DAREN LUCAS
Title or Position: OWNER
Credential:
Phone: 541-639-4400