Basic Information
Provider Information | |||||||||
NPI: | 1700182425 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CASCADE HOSPICE & PALLIATIVE CARE CONSULTING, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4355 W RIDGE DR | ||||||||
Address2: |   | ||||||||
City: | HOOD RIVER | ||||||||
State: | OR | ||||||||
PostalCode: | 970317734 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5417057505 | ||||||||
FaxNumber: | 9712449050 | ||||||||
Practice Location | |||||||||
Address1: | 4355 W RIDGE DR | ||||||||
Address2: |   | ||||||||
City: | HOOD RIVER | ||||||||
State: | OR | ||||||||
PostalCode: | 970317734 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5417057505 | ||||||||
FaxNumber: | 9712449050 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/27/2011 | ||||||||
LastUpdateDate: | 04/27/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PATRIZIO | ||||||||
AuthorizedOfficialFirstName: | GLEN | ||||||||
AuthorizedOfficialMiddleName: | R | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT & MEDICAL DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 5417057505 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | MD60191672 | WA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207QH0002X | MD24391 | OR | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
ID | Type | State | Issuer | Description | 227266 | 05 | OR |   | MEDICAID |