Provider Demographics
NPI:1376103275
Name:PACIFICA HEALTHCARE, LLC
Entity Type:Organization
Organization Name:PACIFICA HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LANGLAIS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-438-7738
Mailing Address - Street 1:6520 SE DUKE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6665
Mailing Address - Country:US
Mailing Address - Phone:808-224-0058
Mailing Address - Fax:
Practice Address - Street 1:25195 SW PARKWAY AVE STE 210
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9689
Practice Address - Country:US
Practice Address - Phone:808-224-0058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty