Provider Demographics
NPI:1790863256
Name:PACIFIC HEALTHCARE, INC.
Entity Type:Organization
Organization Name:PACIFIC HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:219-554-0356
Mailing Address - Street 1:6829-1/2 S. GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46323
Mailing Address - Country:US
Mailing Address - Phone:219-554-0356
Mailing Address - Fax:
Practice Address - Street 1:6829-1/2 S. GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46323
Practice Address - Country:US
Practice Address - Phone:219-554-0356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center