Provider Demographics
NPI:1568868339
Name:PACIFICA SENIOR LIVING OCALA LLC
Entity Type:Organization
Organization Name:PACIFICA SENIOR LIVING OCALA LLC
Other - Org Name:PACIFICA SENIOR LIVING OCALA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
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:619-296-9000
Mailing Address - Street 1:1775 HANCOCK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2034
Mailing Address - Country:US
Mailing Address - Phone:619-296-9000
Mailing Address - Fax:619-296-9090
Practice Address - Street 1:11311 SW 95TH CIR
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-5064
Practice Address - Country:US
Practice Address - Phone:352-861-2088
Practice Address - Fax:352-207-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9315310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL9315OtherAL LICENSE