Healthcare Provider Details

I. General information

NPI: 1649103177
Provider Name (Legal Business Name): PACIFIC HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2043 COLUMBIA DR
TWIN FALLS ID
83301-5983
US

IV. Provider business mailing address

2043 COLUMBIA DR
TWIN FALLS ID
83301-5983
US

V. Phone/Fax

Practice location:
  • Phone: 253-452-5293
  • Fax:
Mailing address:
  • Phone: 253-452-5293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SAGAR KHAPANGI
Title or Position: OWNER
Credential:
Phone: 253-452-5293