Healthcare Provider Details

I. General information

NPI: 1871638023
Provider Name (Legal Business Name): PACIFIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 HARLAN ST
LAKEWOOD CO
80214-1535
US

IV. Provider business mailing address

1595 HARLAN ST
LAKEWOOD CO
80214-1535
US

V. Phone/Fax

Practice location:
  • Phone: 303-237-0941
  • Fax: 303-237-0942
Mailing address:
  • Phone: 303-237-0941
  • Fax: 303-237-0942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number42-39832-0000
License Number StateCO

VIII. Authorized Official

Name: MRS. FATEMEH PANAHI
Title or Position: PRESIDENT
Credential: RN BSN
Phone: 303-377-8833