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	251E00000X	Home Health Agency	131386	OR

General Provider Information

NPI Number	:	1184683336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC HOME CARE ASSOCIATES INC

Provider Business Mailing Address
First Line	:	838 BELTLINE RD
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-1091
Country	:	US
Telephone Number	:	541-746-0482
Fax Number	:	541-746-1685

Provider Business Practice Location Address
First Line	:	838 BELTLINE RD
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-1091
Country	:	US
Telephone Number	:	541-746-0482
Fax Number	:	541-746-1685

Authorized Official
Title or Position	:	CEO
Name	:	DONALD A FREEMAN
Credential	:	RN
Telephone Number	:	405-878-0202

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	04/23/2015

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