Healthcare Provider Details

I. General information

NPI: 1629403894
Provider Name (Legal Business Name): ROGUE VALLEY IN HOME CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 CRATER LAKE AVE
MEDFORD OR
97504-6525
US

IV. Provider business mailing address

712 CRATER LAKE AVE
MEDFORD OR
97504-6525
US

V. Phone/Fax

Practice location:
  • Phone: 541-245-0963
  • Fax: 541-772-0656
Mailing address:
  • Phone: 541-245-0963
  • Fax: 541-772-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number15-2148
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number15.2148
License Number StateOR

VIII. Authorized Official

Name: AMBER MICHELLE PERRINO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 541-245-0963