Provider Demographics
NPI:1124112784
Name:PACIFIC HOME CARE ASSOCIATES, INC.
Entity type:Organization
Organization Name:PACIFIC HOME CARE ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
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 STE 121
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-2005
Mailing Address - Country:US
Mailing Address - Phone:405-878-0202
Mailing Address - Fax:
Practice Address - Street 1:375 PARK AVE STE 6
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2242
Practice Address - Country:US
Practice Address - Phone:541-266-7005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR381524Medicare ID - Type UnspecifiedHOSPICE