Provider Demographics
NPI:1689257974
Name:PACALDO LLC
Entity Type:Organization
Organization Name:PACALDO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:MIRANDA
Authorized Official - Last Name:PACALDO
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:650-393-0265
Mailing Address - Street 1:130 VALE ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2516
Mailing Address - Country:US
Mailing Address - Phone:650-393-0265
Mailing Address - Fax:650-898-1553
Practice Address - Street 1:130 VALE ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2516
Practice Address - Country:US
Practice Address - Phone:650-393-0265
Practice Address - Fax:650-898-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA415601066OtherASSISTED LIVING FACILITY