Healthcare Provider Details

I. General information

NPI: 1104936400
Provider Name (Legal Business Name): PARTNERS IN CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 NE WYATT CT BLDG B
BEND OR
97701-7686
US

IV. Provider business mailing address

2075 NE WYATT CT
BEND OR
97701-7686
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-5882
  • Fax: 541-388-4221
Mailing address:
  • Phone: 541-382-5882
  • Fax: 541-633-1590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number07-00000440
License Number StateOR

VIII. Authorized Official

Name: MR. GREGORY DUANE HAGFORS
Title or Position: CEO
Credential:
Phone: 541-382-5882