Basic Information
| Provider Information | |||||||||
| NPI: | 1053830026 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFICA SL LYNNWOOD LLC | ||||||||
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| OtherOrganizationName: | PACIFICA SENIOR LIVING LYNNWOOD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1775 HANCOCK ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921102036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192969000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18625 60TH AVE W | ||||||||
| Address2: | |||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980374300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257717700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2017 | ||||||||
| LastUpdateDate: | 09/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | ISRANI | ||||||||
| AuthorizedOfficialFirstName: | DEEPAK | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL MANAGER | ||||||||
| 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.