MEDICARE: PACIFIC HOME CARE ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency		OR

General Provider Information

NPI Number	:	1124112784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC HOME CARE ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	120 W MACARTHUR ST STE 121
Second Line	:
City	:	SHAWNEE
State	:	OK
Zip	:	74804-2005
Country	:	US
Telephone Number	:	405-878-0202
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 PARK AVE STE 6
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2242
Country	:	US
Telephone Number	:	541-266-7005
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DONALD A FREEMAN
Credential	:
Telephone Number	:	405-878-0202

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	01/12/2024

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