1316307440 NPI number — PACIFICA SL MCMINNVILLE LLC

Table of content: SYDNEY G. REPHAN RD (NPI 1578860094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316307440 NPI number — PACIFICA SL MCMINNVILLE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFICA SL MCMINNVILLE LLC
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:
PACIFICA SENIOR LIVING MCMINNVILLE
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:
1316307440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1775 HANCOCK ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92110-2034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-296-9000
Provider Business Mailing Address Fax Number:
619-296-9090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 SW HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCMINNVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97128-9133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-472-3509
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ISRANI
Authorized Official First Name:
DEEPAK
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
619-296-9000

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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