Provider Demographics
NPI:1740029610
Name:PACIFIC SUN SENIOR CARE
Entity type:Organization
Organization Name:PACIFIC SUN SENIOR CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MUQEET
Authorized Official - Middle Name:
Authorized Official - Last Name:DADABHOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-251-2382
Mailing Address - Street 1:PO BOX 7785
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-9185
Mailing Address - Country:US
Mailing Address - Phone:310-251-2382
Mailing Address - Fax:
Practice Address - Street 1:24532 SPARTAN ST
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4529
Practice Address - Country:US
Practice Address - Phone:310-251-2382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAND PACIFIC SUN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-21
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health