Provider Demographics
NPI:1184683336
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:405-878-0202
Mailing Address - Street 1:838 BELTLINE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1091
Mailing Address - Country:US
Mailing Address - Phone:541-746-0482
Mailing Address - Fax:541-746-1685
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:2006-03-17
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR131386251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
387059Medicare Oscar/Certification
387059Medicare Oscar/Certification