Provider Demographics
NPI:1982367181
Name:PACIFIC HEALTH HOME CARE LLC
Entity Type:Organization
Organization Name:PACIFIC HEALTH HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:PHI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-572-5549
Mailing Address - Street 1:15411 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6322
Mailing Address - Country:US
Mailing Address - Phone:949-572-5549
Mailing Address - Fax:
Practice Address - Street 1:19634 VENTURA BLVD STE 213
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6018
Practice Address - Country:US
Practice Address - Phone:949-572-5549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health