Provider Demographics
NPI:1982614517
Name:PCC HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PCC HEALTH SERVICES, INC.
Other - Org Name:EMMANUEL HEALTH CARE GLENDORA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:PADRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-248-9808
Mailing Address - Street 1:2258 FOOTHILL BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1476
Mailing Address - Country:US
Mailing Address - Phone:818-248-9808
Mailing Address - Fax:818-731-1454
Practice Address - Street 1:805 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5413
Practice Address - Country:US
Practice Address - Phone:626-331-0781
Practice Address - Fax:626-332-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06079JMedicaid
CA05-6079Medicare ID - Type UnspecifiedMUTUAL OF OMAHA