Basic Information
| Provider Information | |||||||||
| NPI: | 1053746511 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PACIFICA SHERMAN LLC | ||||||||
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| OtherOrganizationName: | THE COURTYARD COEUR D'ALENE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1775 HANCOCK ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921102034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192969000 | ||||||||
| FaxNumber: | 6192969090 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 E SHERMAN AVE | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838145335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082157166 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2013 | ||||||||
| LastUpdateDate: | 09/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | ISRANI | ||||||||
| AuthorizedOfficialFirstName: | DEEPAK | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6192969000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.