Provider Demographics
NPI:1295372936
Name:PACIFICA SL PHOENIX LLC
Entity Type:Organization
Organization Name:PACIFICA SL PHOENIX LLC
Other - Org Name:
Other - Org Type:
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:623-404-4047
Mailing Address - Street 1:1775 HANCOCK STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110
Mailing Address - Country:US
Mailing Address - Phone:619-296-9000
Mailing Address - Fax:619-296-9090
Practice Address - Street 1:17207 NORTH BOSWELL BOULEVARD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373
Practice Address - Country:US
Practice Address - Phone:623-404-4047
Practice Address - Fax:623-583-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility