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General NPI Number Information
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NPI Number | 1730468448
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Entity Type | Organization
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Legal Business Name | PACIFIC HOME CARE, LLC
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 4713 W 130TH ST
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City | CLEVELAND
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State | OH
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Zip | 44135-3705
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Country | US
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Telephone | 216-458-5756
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Fax | 216-812-1121
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Provider Business Mailing Address
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Address Line | 4713 W 130TH ST
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City | CLEVELAND
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State | OH
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Zip | 44135-3705
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Country | US
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Telephone | 216-458-5756
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Fax | 216-812-1121
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Authorized Official
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Title or Position | MANAGER
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Name | ABDULLAHI A ALI
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Credential |
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Telephone | 216-396-5051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 201122200526
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License Number State | OH
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