=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932586070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTALCARE THERAPIES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2015
-----------------------------------------------------
Last Update Date | 04/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20845 GREENMONT DR
-----------------------------------------------------
City | BEND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97702-2857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-401-8560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20845 GREENMONT DR
-----------------------------------------------------
City | BEND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97702-2857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-401-8560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. CHRISTOPHER ANTHONY GROSSMAN
-----------------------------------------------------
Credential | M.S. P.T.
-----------------------------------------------------
Telephone | 505-401-8560
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------