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General NPI Number Information
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NPI Number | 1407736135
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Entity Type | Organization
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Legal Business Name | PACIFIC HEALTH SYSTEM LLC
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 4625 E BROADWAY BLVD STE 218
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City | TUCSON
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State | AZ
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Zip | 85711-3576
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Country | US
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Telephone | 678-480-5315
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Fax | 678-669-1693
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Provider Business Mailing Address
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Address Line | 4625 E BROADWAY BLVD STE 218
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City | TUCSON
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State | AZ
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Zip | 85711-3576
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Country | US
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Telephone | 678-480-5315
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Fax | 678-669-1693
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Authorized Official
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Title or Position | PRESIDENT
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Name | REMIGIUS IMIMOLE IDAEWOR
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Credential |
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Telephone | 678-480-5315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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