Provider Demographics
NPI:1982172995
Name:PACIFICA AUGUSTINE ROAD LLC
Entity Type:Organization
Organization Name:PACIFICA AUGUSTINE ROAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-296-9000
Mailing Address - Street 1:1775 HANCOCK STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110
Mailing Address - Country:US
Mailing Address - Phone:619-296-9000
Mailing Address - Fax:619-296-9090
Practice Address - Street 1:10660 OLD AUGUSTINE ROAD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257
Practice Address - Country:US
Practice Address - Phone:914-262-4600
Practice Address - Fax:904-262-1939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)