Provider Demographics
NPI:1780836197
Name:PACIFIC HOME CARE ASSOCIATES
Entity Type:Organization
Organization Name:PACIFIC HOME CARE ASSOCIATES
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 1:4660 MAIN ST
Practice Address - Street 2:BUILDING A, 100-2
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-6087
Practice Address - Country:US
Practice Address - Phone:541-746-0482
Practice Address - Fax:541-746-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
38-1524Medicare PIN