Healthcare Provider Details

I. General information

NPI: 1922834431
Provider Name (Legal Business Name): PACIFIC CARE FACILITIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 AVENIDA PALMDALE
FREMONT CA
94539-5356
US

IV. Provider business mailing address

PO BOX 4730
MODESTO CA
95352-4730
US

V. Phone/Fax

Practice location:
  • Phone: 510-954-3478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: TALWINDERDEEP KAHLON
Title or Position: MEMBER
Credential:
Phone: 510-954-3478