Healthcare Provider Details

I. General information

NPI: 1124210497
Provider Name (Legal Business Name): PACIFIC ADHC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16861 PARTHENIA ST
NORTHRIDGE CA
91343-4539
US

IV. Provider business mailing address

16861 PARTHENIA ST
NORTHRIDGE CA
91343-4539
US

V. Phone/Fax

Practice location:
  • Phone: 818-776-8700
  • Fax: 818-776-8789
Mailing address:
  • Phone: 818-776-8700
  • Fax: 818-776-8789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000692
License Number StateCA

VIII. Authorized Official

Name: MR. CHAE WANG KIM
Title or Position: CEO
Credential:
Phone: 818-776-8700