Provider Demographics
NPI:1144737107
Name:PACIFIC GARDENS MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:PACIFIC GARDENS MEDICAL CENTER, LLC
Other - Org Name:PACIFIC GARDENS MEDICAL CENTER, HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT-CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-287-6308
Mailing Address - Street 1:700 17TH ST STE 201D
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21530 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2608
Practice Address - Country:US
Practice Address - Phone:562-860-0401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC GARDENS MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-29
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health