Provider Demographics
NPI:1891857389
Name:PACIFICA OF THE VALLEY CORPORATION
Entity Type:Organization
Organization Name:PACIFICA OF THE VALLEY CORPORATION
Other - Org Name:PACIFIC HOSPITAL OF THE VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-252-2196
Mailing Address - Street 1:9449 SAN FERNANDO ROAD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352
Mailing Address - Country:US
Mailing Address - Phone:818-767-3310
Mailing Address - Fax:818-252-2291
Practice Address - Street 1:9449 SAN FERNANDO ROAD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352
Practice Address - Country:US
Practice Address - Phone:818-767-3310
Practice Address - Fax:818-252-2291
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFICA OF THE VALLEY CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000148282N00000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC 55217GMedicaid
CALTC 55217GMedicaid