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General NPI Number Information
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NPI Number | 1982172995
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Entity Type | Organization
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Legal Business Name | PACIFICA AUGUSTINE ROAD LLC
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 10660 OLD AUGUSTINE ROAD
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City | JACKSONVILLE
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State | FL
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Zip | 32257
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Country | US
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Telephone | 914-262-4600
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Fax | 904-262-1939
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Provider Business Mailing Address
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Address Line | 1775 HANCOCK STREET SUITE 200
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City | SAN DIEGO
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State | CA
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Zip | 92110
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Country | US
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Telephone | 619-296-9000
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Fax | 619-296-9090
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DEEPAK ISRANI
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Credential |
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Telephone | 619-296-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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