Provider Demographics
NPI:1104518851
Name:PACIFIC KARE LLC
Entity type:Organization
Organization Name:PACIFIC KARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MOERKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-228-9634
Mailing Address - Street 1:1645 WINTERGREEN LN UNIT D
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-2670
Mailing Address - Country:US
Mailing Address - Phone:562-228-9634
Mailing Address - Fax:
Practice Address - Street 1:1645 WINTERGREEN LN UNIT D
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-2670
Practice Address - Country:US
Practice Address - Phone:562-228-9634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health