Provider Demographics
NPI:1316307440
Name:PACIFICA SL MCMINNVILLE LLC
Entity type:Organization
Organization Name:PACIFICA SL MCMINNVILLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
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 ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2034
Mailing Address - Country:US
Mailing Address - Phone:619-296-9000
Mailing Address - Fax:619-296-9090
Practice Address - Street 1:320 SW HILL RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-9133
Practice Address - Country:US
Practice Address - Phone:503-472-3509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility