Provider Demographics
NPI:1366187973
Name:PIERCE, CHARLES (CAREGIVER)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:PIERCE
Suffix:
Gender:M
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GLASS LN
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-9529
Mailing Address - Country:US
Mailing Address - Phone:541-324-9835
Mailing Address - Fax:
Practice Address - Street 1:120 GLASS LN
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-9529
Practice Address - Country:US
Practice Address - Phone:541-324-9835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator