Provider Demographics
NPI:1710200498
Name:PACIFIC HOME CARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PACIFIC HOME CARE ASSOCIATES, INC.
Other - Org Name:PACIFIC HOME HEALTH AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-878-0202
Mailing Address - Street 1:120 W MACARTHUR ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-2007
Mailing Address - Country:US
Mailing Address - Phone:405-878-0202
Mailing Address - Fax:405-273-6007
Practice Address - Street 1:838 BELTLINE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1091
Practice Address - Country:US
Practice Address - Phone:541-746-0482
Practice Address - Fax:541-746-1685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR387059Medicare UPIN