Provider Demographics
NPI:1073247888
Name:PACIFICEMDR LLC
Entity Type:Organization
Organization Name:PACIFICEMDR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LILY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:971-341-7542
Mailing Address - Street 1:2034 COLUMBIA BLVD # 154
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-1737
Mailing Address - Country:US
Mailing Address - Phone:971-341-7542
Mailing Address - Fax:
Practice Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY STE 560
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4791
Practice Address - Country:US
Practice Address - Phone:971-341-7542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-16
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health