1548633472 NPI number — PACIFIC SUNRISE HOME INC.

Table of content: (NPI 1548633472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548633472 NPI number — PACIFIC SUNRISE HOME INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC SUNRISE HOME INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PACIFIC SUNRISE HOME 1
Provider Other Organization Name Type Code:
3
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:
1548633472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28134 LOMO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO PALOS VERDES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90275-3226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
424-777-8602
Provider Business Mailing Address Fax Number:
424-206-9069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28134 LOMO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO PALOS VERDES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90275-3226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-777-8707
Provider Business Practice Location Address Fax Number:
424-206-2486
Provider Enumeration Date:
10/30/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CANTORIA
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
LOIDA
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
310-500-7223

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  197607766 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 198320035 . This is a "DEPARTMENT OF SOCIAL SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".