Provider Demographics
NPI:1568915809
Name:PACIFIC HEALTH SYSTEMS LLC
Entity Type:Organization
Organization Name:PACIFIC HEALTH SYSTEMS LLC
Other - Org Name:PACIFIC HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REMIGIUS
Authorized Official - Middle Name:I
Authorized Official - Last Name:IDAEWOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-480-5315
Mailing Address - Street 1:110 EAGLE SPRING DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6488
Mailing Address - Country:US
Mailing Address - Phone:678-480-5315
Mailing Address - Fax:404-745-0340
Practice Address - Street 1:110 EAGLE SPRING DR
Practice Address - Street 2:SUITE C
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6488
Practice Address - Country:US
Practice Address - Phone:678-480-5315
Practice Address - Fax:404-745-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075-R-1482251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health