Provider Demographics
NPI:1053830026
Name:PACIFICA SL LYNNWOOD LLC
Entity Type:Organization
Organization Name:PACIFICA SL LYNNWOOD LLC
Other - Org Name:PACIFICA SENIOR LIVING LYNNWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-296-9000
Mailing Address - Street 1:1775 HANCOCK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2036
Mailing Address - Country:US
Mailing Address - Phone:619-296-9000
Mailing Address - Fax:
Practice Address - Street 1:18625 60TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4300
Practice Address - Country:US
Practice Address - Phone:425-771-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility