Healthcare Provider Details

I. General information

NPI: 1144247115
Provider Name (Legal Business Name): PACIFIC SENIOR CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 NE 5TH ST
GRESHAM OR
97030
US

IV. Provider business mailing address

127 NE 102ND AVE STE A
PORTLAND OR
97220
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-5600
  • Fax: 503-907-8911
Mailing address:
  • Phone: 503-254-7923
  • Fax: 503-764-9974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAUL REDHEAD
Title or Position: MANAGING MEMBER
Credential:
Phone: 541-954-1937