Healthcare Provider Details

I. General information

NPI: 1982172995
Provider Name (Legal Business Name): PACIFICA AUGUSTINE ROAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10660 OLD AUGUSTINE ROAD
JACKSONVILLE FL
32257
US

IV. Provider business mailing address

1775 HANCOCK STREET SUITE 200
SAN DIEGO CA
92110
US

V. Phone/Fax

Practice location:
  • Phone: 914-262-4600
  • Fax: 904-262-1939
Mailing address:
  • Phone: 619-296-9000
  • Fax: 619-296-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: DEEPAK ISRANI
Title or Position: MANAGING PARTNER
Credential:
Phone: 619-296-9000