Healthcare Provider Details

I. General information

NPI: 1972719037
Provider Name (Legal Business Name): PACIFIC PALMS HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 TERMINO AVE
LONG BEACH CA
90804-4123
US

IV. Provider business mailing address

1020 TERMINO AVE
LONG BEACH CA
90804-4123
US

V. Phone/Fax

Practice location:
  • Phone: 562-433-6791
  • Fax: 562-433-9801
Mailing address:
  • Phone: 562-433-6791
  • Fax: 562-433-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. EMMANUEL B DAVID
Title or Position: GOVERNING BOARD MEMBER
Credential:
Phone: 310-320-6319