| Senior Age in Place Support | |
|
19704 Hollygrape St Bend OR 97702-2571 | |
| (541) 550-1246 | |
| Not Available |
| Full Name | Senior Age in Place Support |
|---|---|
| Speciality | Clinic/Center |
| Location | 19704 Hollygrape St, Bend, Oregon |
| Authorized Official Name and Position | Christina Lynn Rhyne (SOLE MEMBER) |
| Authorized Official Contact | 5415501246 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Senior Age in Place Support 19704 Hollygrape St Bend OR 97702-2571 Ph: (541) 550-1246 | Senior Age in Place Support 19704 Hollygrape St Bend OR 97702-2571 Ph: (541) 550-1246 |
| NPI Number | 1255206744 |
|---|---|
| Provider Enumeration Date | 10/06/2025 |
| Last Update Date | 10/06/2025 |
| Certification Date | 10/06/2025 |
| Medicare PECOS PAC ID | 3375029846 |
|---|---|
| Medicare Enrollment ID | O20260114003618 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255206744 | NPI | - | NPPES |
| Provider Name | William B Cottrell |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1114362852 PECOS PAC ID: 6305293465 Enrollment ID: I20231110000830 |
| Provider Name | Jasmine Rose Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306514625 PECOS PAC ID: 1759788086 Enrollment ID: I20251217003863 |
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