MEDICARE: PACIFIC HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1912839127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC HOME CARE LLC

Provider Business Mailing Address
First Line	:	2043 COLUMBIA DR
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5983
Country	:	US
Telephone Number	:	253-452-5293
Fax Number	:

Provider Business Practice Location Address
First Line	:	2043 COLUMBIA DR
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5983
Country	:	US
Telephone Number	:	253-452-5293
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAGAR KHAPANGI
Credential	:
Telephone Number	:	253-452-5293

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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