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General NPI Number Information
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NPI Number | 1801038724
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Entity Type | Organization
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Legal Business Name | PACIFIC CARE CENTER LLC
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 105 SOUTH SIXTH STREET
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City | PACIFIC
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State | MO
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Zip | 63069
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Country | US
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Telephone | 636-271-4222
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Fax | 636-257-8002
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Provider Business Mailing Address
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Address Line | 105 SOUTH SIXTH STREET
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City | PACIFIC
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State | MO
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Zip | 63069
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Country | US
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Telephone | 636-271-4222
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Fax | 636-257-8002
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. GRETCHEN R ROBERTS-HOAGLIN
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Credential | R.N. LICENSED NURSIN
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Telephone | 636-271-4222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 036467
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License Number State | MO
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