Provider Demographics
NPI:1003891516
Name:PACIFICA LINDA MAR INC.
Entity Type:Organization
Organization Name:PACIFICA LINDA MAR INC.
Other - Org Name:LINDA MAR CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-373-8373
Mailing Address - Street 1:25910 ACERO STE 350
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-7908
Mailing Address - Country:US
Mailing Address - Phone:949-441-9258
Mailing Address - Fax:
Practice Address - Street 1:751 SAN PEDRO TERRACE RD
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-4101
Practice Address - Country:US
Practice Address - Phone:650-359-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05116KMedicaid
CA4248090001Medicare NSC
CA055116Medicare Oscar/Certification