Healthcare Provider Details

I. General information

NPI: 1982691366
Provider Name (Legal Business Name): PACIFIC HEALTHCARE & REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 HARRISON AVE
EUREKA CA
95501-3214
US

IV. Provider business mailing address

2211 HARRISON AVE
EUREKA CA
95501-3214
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-9767
  • Fax: 707-441-8447
Mailing address:
  • Phone: 707-443-9767
  • Fax: 707-441-8447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number010000051
License Number StateCA

VIII. Authorized Official

Name: MS. ALICE L O'NEILL
Title or Position: ADMINISTRATOR
Credential: MS,RD, NHS
Phone: 707-443-9767