Provider Demographics
NPI:1912253055
Name:PALLIATIVE CONNECTIONS OF CALIFORNIA INC
Entity Type:Organization
Organization Name:PALLIATIVE CONNECTIONS OF CALIFORNIA INC
Other - Org Name:PALLIATIVE TRANSITIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LACKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-412-4909
Mailing Address - Street 1:5314 S YALE AVE STE 900
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6257
Mailing Address - Country:US
Mailing Address - Phone:918-710-3576
Mailing Address - Fax:918-516-0609
Practice Address - Street 1:11230 SORRENTO VALLEY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1332
Practice Address - Country:US
Practice Address - Phone:918-894-3487
Practice Address - Fax:918-712-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X, 163WC0400X, 163WH0200X, 163WP0000X, 164W00000X, 363A00000X, 363L00000X
CAA80423171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA80423Medicaid
CAA80423Medicare Oscar/Certification