Provider Demographics
NPI:1477297034
Name:PACIFIC HEALTHCARE, LLC
Entity Type:Organization
Organization Name:PACIFIC HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BERHE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMESGHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-712-5351
Mailing Address - Street 1:23417 93RD AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-5608
Mailing Address - Country:US
Mailing Address - Phone:206-712-5351
Mailing Address - Fax:
Practice Address - Street 1:23417 93RD AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5608
Practice Address - Country:US
Practice Address - Phone:206-712-5351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility