1760224331 NPI number — KATHARYN BRANDI LACRE DDPSW BHPCA CHW

Table of content: KATHARYN BRANDI LACRE DDPSW BHPCA CHW (NPI 1760224331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760224331 NPI number — KATHARYN BRANDI LACRE DDPSW BHPCA CHW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LACRE
Provider First Name:
KATHARYN
Provider Middle Name:
BRANDI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDPSW BHPCA CHW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760224331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 SW CENTURY DR STE 100-1079
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97702-3557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-977-7078
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 SW CENTURY DR STE 100-1079
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97702-3557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-977-7078
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 172V00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1744R1102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 176B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374J00000X , with the licence number: THW000110802 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083P0901X , with the licence number: NA , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 864218 . This is a "PCA-PDC (OHCC) PERSONAL CARE PROFESSIONAL CERTIFIED" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 865890 . This is a "IDD-PSW OREGON STATE PLAN PERSONAL CARE SERVICES (SPPC/84-800) OHA" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "PCD-POSTPARTUM DOULA (SIMKIN CENTER FOR ALLIED BIRTH VOCATIONS)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 864218 . This is a "MH-PC20 AMH-PERSONAL CARE SERVICES 20 (OREGON HEALTH AUTHORITY)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 868421 . This is a "HCW-PDC HOME CARE PROFESSIONAL CERTIFIED (OHCC)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "PWS-PEER WELLNESS SPECIALIST (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: THW000110802 . This is a "THW-TRADITIONAL HEALTH WORKER (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: THW000110802 . This is a "PSS-ADULT ADDICTIONS (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: THW000110802 . This is a "YSS-YOUTH SUPPORT SPECIALIST (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "CD-BIRTH DOULA (SIMKIN CENTER FOR ALLIED BIRTH VOCATIONS)" identifier . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "PSS-MENTAL HEALTH (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 865890 . This is a "PSW-EC (OHCC) PERSONAL SUPPORT ENHANCED CERTIFIED" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: COS-FT-10184774 . This is a "AESTHETICIAN (OHA-BOARD OF COSMETOLOGY)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "CRM-ADULT ADDICTIONS RECOVERY (MHACBO)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: THW000110802 . This is a "PSS-PEER SUPPORT SPECIALIST (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 868421 . This is a "HCW-AGING AND PEOPLE WITH DISABILITIES (ODHS)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "FSS-FAMILY SUPPORT SPECIALIST (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: THW000110802 . This is a "CHW-COMMUNITY HEALTH WORKER (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 864218 . This is a "BHPCA - OREGON MEDICAID BEHAVIORAL HEALTH PERSONAL CARE PROGRAM (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 868421 . This is a "HCW-EC HOME CARE ENHANCED CERTIFIED (OHCC)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com