MEDICARE: PACIFIC CARE SERVICES LLC

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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1699585612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	2018 ADDERBURY LN
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-4002
Country	:	US
Telephone Number	:	608-338-7752
Fax Number	:

Provider Business Practice Location Address
First Line	:	2018 ADDERBURY LN
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-4002
Country	:	US
Telephone Number	:	608-338-7752
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABDIRASHID AHMED
Credential	:
Telephone Number	:	608-338-7752

Provider Enumeration Date	:	01/10/2025
Last Update Date	:	01/10/2025

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