Healthcare Provider Details

I. General information

NPI: 1205020559
Provider Name (Legal Business Name): PACIFIC HOME HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17420 AVALON BLVD SUITE 200
CARSON CA
90746-1564
US

IV. Provider business mailing address

17420 AVALON BLVD SUITE 200
CARSON CA
90746-1564
US

V. Phone/Fax

Practice location:
  • Phone: 310-538-3133
  • Fax: 310-538-3233
Mailing address:
  • Phone: 310-538-3133
  • Fax: 310-538-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberNON YET
License Number StateCA

VIII. Authorized Official

Name: MR. PHILIP E ARABOME
Title or Position: DIRECTOR OF NURSES
Credential: RN, MS
Phone: 310-538-3133