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General NPI Number Information
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NPI Number | 1043157324
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Entity Type | Organization
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Legal Business Name | PACIFIC BREEZE AFH LLC
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 16017 NE 79TH WAY
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City | VANCOUVER
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State | WA
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Zip | 98682-1541
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Country | US
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Telephone | 360-605-8930
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Fax | 360-251-0313
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Provider Business Mailing Address
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Address Line | 16017 NE 79TH WAY
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City | VANCOUVER
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State | WA
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Zip | 98682-1541
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Country | US
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Telephone | 360-605-8930
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Fax | 360-251-0313
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Authorized Official
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Title or Position | RESIDENT MANAGER
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Name | HABTE SIMON
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Credential | PHARMD
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Telephone | 360-605-8930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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