Basic Information
| Provider Information | |||||||||
| NPI: | 1447600796 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASCADE HOSPICE & PALLIATIVE CARE CONSULTING, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4355 W RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | HOOD RIVER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970317734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417057505 | ||||||||
| FaxNumber: | 5412449050 | ||||||||
| Practice Location | |||||||||
| Address1: | 4355 W RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | HOOD RIVER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970317734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417057505 | ||||||||
| FaxNumber: | 5412449050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2016 | ||||||||
| LastUpdateDate: | 06/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | PATRIZIO | ||||||||
| AuthorizedOfficialFirstName: | GLEN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5417057505 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | MD60191672 | WA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207QH0002X | MD24391 | OR | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 227266 | 05 | OR | MEDICAID |