MEDICARE: CASCADE IN HOME CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	15-2219	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215301163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASCADE IN HOME CARE, LLC

Provider Business Mailing Address
First Line	:	2195 NE PROFESSIONAL CT
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6028
Country	:	US
Telephone Number	:	541-633-7436
Fax Number	:	541-633-7438

Provider Business Practice Location Address
First Line	:	2195 NE PROFESSIONAL CT
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6028
Country	:	US
Telephone Number	:	541-633-7436
Fax Number	:	541-633-7438

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	GINNIS MENEFEE
Credential	:
Telephone Number	:	541-633-7436

Provider Enumeration Date	:	11/16/2015
Last Update Date	:	11/16/2015

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Directions to “CASCADE IN HOME CARE, LLC ” Practice Location

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