Provider Demographics
NPI:1326071002
Name:PACIFICA HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:PACIFICA HEALTH SERVICES LLC
Other - Org Name:CARLISLE CENTER FOR WELLNESS REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:WOLNERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, FASCP
Authorized Official - Phone:515-285-2559
Mailing Address - Street 1:680 COLE ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:IA
Mailing Address - Zip Code:50047-8763
Mailing Address - Country:US
Mailing Address - Phone:515-989-0871
Mailing Address - Fax:515-989-0007
Practice Address - Street 1:680 COLE ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-8763
Practice Address - Country:US
Practice Address - Phone:515-989-0871
Practice Address - Fax:515-989-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA910796313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA34700Medicaid
IA165255Medicare Oscar/Certification