Provider Demographics
NPI:1902248776
Name:CASCADE DIRECT CARE INC
Entity Type:Organization
Organization Name:CASCADE DIRECT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:541-362-8688
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-0648
Mailing Address - Country:US
Mailing Address - Phone:541-362-8688
Mailing Address - Fax:
Practice Address - Street 1:750 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1436
Practice Address - Country:US
Practice Address - Phone:541-362-8688
Practice Address - Fax:541-550-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA151672363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty