Basic Information
| Provider Information | |||||||||
| NPI: | 1164675963 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASCADE HEALTHCARE COMMUNITY INC | ||||||||
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| OtherOrganizationName: | NW HIGH DESERT SLEEP CENTER BEND | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2042 NE WILLIAMSON CT | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977013760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417066905 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2042 NE WILLIAMSON CT | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977013760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417066905 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2008 | ||||||||
| LastUpdateDate: | 11/10/2008 | ||||||||
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| AuthorizedOfficialLastName: | BRICKER | ||||||||
| AuthorizedOfficialFirstName: | TIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5417067701 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.